Pharmacy Manager, Medical Pharmacy

Medica • St. Louis, MO

7d • $113,400 - $194,400 • Hybrid

About The Position

The Pharmacy Manager, Medical Pharmacy is a member of the pharmacy leadership team. The incumbent has responsibility and accountability for overseeing the medical pharmacy clinical, financial, and operational strategy for all business segments including IFB, Commercial, Medicaid and Medicare. Key accountabilities include, but are not limited to, leading medical pharmacy policy development and utilization management for all segments, new medical drug clinical assessment and management strategy; and oversight for both internal and delegated medical pharmacy management services. This will include navigating cross-functional processes and systems both within and external to the organization. Performs other duties as assigned.

Requirements

• Bachelor's degree in Pharmacy or PharmD required
• 5+ years of related work experience in health plan pharmacy, PBM clinical management, or related clinical leadership beyond degree
• Active MN pharmacist license, or eligible for MN pharmacist license

Nice To Haves

• Demonstrated experience with: Medical pharmacy drug policies, Medical pharmacy claims processing, Delegate management
• Experience working within regulated environments (Medicare and/or Medicaid)
• Board certification (e.g., BCPS or other relevant specialty)
• Experience in plan led or hybrid PBM models
• Familiarity with accreditation and regulatory frameworks (e.g., CMS, NCQA)
• Leadership experience overseeing clinical pharmacists or matrixed teams
• Clinical credibility and sound judgment
• Strong governance mindset and attention to consistency
• Ability to translate evidence into practical, defensible clinical positions
• Executive level presentation and communication skills
• Collaborative, cross functional leadership

Responsibilities

• Provides oversight and support for all aspects of the medical pharmacy benefit, including elements such as drug policies, clinical services, operational processes and utilization management.
• Develops and implements strategies to manage medical drug costs and improve member outcomes consistent across all segments and markets.
• Prepares and presents medical drug reviews at Medica’s formal approval committee.
• Reviews and analyzes medical drug utilization data to ensure optimal usage of medications.
• Ensures access to cost-effective medical drugs for our customers.
• Develops and implements medical pharmacy policies and procedures.
• Ensures compliance with regulatory standards across all segments and markets.
• Ensures the efficient and effective delivery of medical pharmacy services for customers.
• Represents medical pharmacy services and actively participates in both internal and external cross-functional meetings.
• Maintains up-to-date knowledge of new drugs, therapeutic trends, and healthcare laws and regulations.
• Maintains accurate and current records of all medical pharmacy decisions and changes.
• Addresses inquiries and disputes related to medical pharmacy authorization decisions.
• Identifies areas of operational improvements for medical pharmacy management.
• Oversees day-to-day processes associated with maintaining medical pharmacy services. Facilitates identification and resolution of barriers so that internal and vendor-delegated programs are implemented and functioning in a high quality, timely, and compliant manner.
• Provides leadership, development, guidance, recognition and oversight of direct reports.
• Serves as a mentor to staff with a set of goals and objectives that are clear and results-oriented.
• Coordinate workload, prioritization, and resource allocation to ensure timely delivery of clinical deliverables.
• Support knowledge development, standard work, and process improvement within the medical pharmacy function.
• Hires, develops, trains and retains high quality staff.
• Fosters a collaborative, value-driven team culture of high standards and strong productivity.
• Develops and maintains positive relationships with Medica leaders, key vendors, and colleagues within the pharmaceutical industry.
• Serve as a clinical escalation point for complex or high-risk pharmacy issues.
• Partner with regulatory, compliance, legal, and quality teams to ensure governance processes meet oversight expectations.
• Manage stakeholder relationships with internal and external partners.
• Communicate medical pharmacy strategy clearly to both clinical and non-clinical audiences.

Benefits

• competitive medical, dental, vision, PTO, Holidays, paid volunteer time off, 401K contributions, caregiver services

What This Job Offers

• Job Type: Full-time
• Career Level: Manager