Manager, Pharmacy Utilization Management
About The Position
The Manager, Pharmacy Utilization Management is a newly created leadership role combining clinical expertise and operational leadership to shape Premera’s Pharmacy Utilization Management function. The position connects the department’s strategic direction with the evolving needs of review operations and supports a unified approach across pharmacy benefit and medical benefit drugs as workforce models, workflows, and technology evolve. The manager oversees team activities and performance, supports the strategic delivery and ongoing improvement of pharmacy clinical programs and operations, and provides pharmacy-related clinical and business support to Sales and Marketing. The role also manages pharmacy content for RFPs, contributes to special projects, and may be assigned internal controls under Premera’s internal controls framework, with accountability for understanding and ensuring those controls operate effectively.
Requirements
- Pharmacist with an advanced degree, such as a PharmD, MBA, MHA, or MPH.
- Active state pharmacist license.
- Six years of pharmacy experience, including at least two years focused on any combination of clinical program development or pharmacy consulting in a pharmacy benefit management organization or health plan.
- Demonstrated ability to lead and manage multiple complex, concurrent projects or teams.
- Ability to communicate effectively verbally and in writing, with strong presentation skills.
- Ability to build and maintain relationships with internal and external individuals.
- Strong analytical skills, including experience analyzing trends and making recommendations based on analysis.
- Working knowledge of local and regional healthcare issues.
- Ability to work independently and as part of a team.
- Intermediate skills in Microsoft Word, Excel, PowerPoint, and Outlook.
- Experience or certification in LEAN, Six Sigma, or another process improvement program.
Nice To Haves
- Completion of an American Society of Health-System Pharmacists (ASHP)-accredited residency program.
- Project management experience.
- Managed care pharmacy experience.
Responsibilities
- Oversee day-to-day team activities, including staff management, achievement of department goals, and team effectiveness.
- Ensure clinical programs, operations, and consulting support Premera’s Pharmacy Program strategy and meet customer needs.
- Develop and maintain monitoring and continuous-improvement strategies for pharmacy clinical programs, operations, or consulting.
- Oversee drug utilization management and prior authorization across medical and pharmacy benefits.
- Oversee pharmacy quality accreditation reporting, documentation, and required procedures.
- Manage pharmacy benefit manager and other vendor setup, testing, and issue resolution.
- Manage specialty pharmacy setup and testing, and handle escalated specialty pharmacy customer issues.
- Oversee formulary programs and promotions, including the Pharmacy and Therapeutics Committee.
- Hire, manage performance, train, and support the professional development of team members.
- Provide clinical training and business support on pharmacy and medical management strategies and solutions to Sales and Marketing, including pharmacy benefit sales to current and prospective clients.
- Contribute to and manage pharmacy and clinical/medical management content in Requests for Proposals.
- Complete special projects and other assigned duties.
- Understand assigned internal controls and their impacts on Premera, and ensure they operate effectively.
Benefits
- Medical, vision, and dental coverage with low employee premiums.
- Voluntary benefits, including pet insurance.
- Life and disability insurance.
- Retirement programs, including a 401(k) employer match and a pension plan vested after three years of service.
- Wellness incentives and mental well-being resources for employees and dependents, including counseling, stress management, and mindfulness programs.
- Generous paid time off.
- Tuition assistance for undergraduate and graduate degrees.
- Employee recognition program.
- Hybrid employees have access to on-campus resources, networking opportunities, and team engagement.
- Commuter perks.
- Free on-site parking.
- Subsidized on-campus cafes.
- On-site activities, including health and wellness events, coffee connects, and disaster preparedness fairs.
- Fitness and well-being center with in-person and virtual workouts and nutritional counseling.
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What This Job Offers
Job Type
Full-time
Career Level
Manager
