Pharmacy Policy and Program Specialist
About The Position
The Iowa Medicaid program is seeking a detail-oriented, policy-focused professional to guide and strengthen pharmacy benefit operations. This role serves as a policy and program expert for the Physician Administered Drug (PAD) and Outpatient Prescribed Drug (OPD) benefits, ensuring consistent, compliant, and high-quality implementation of federal and state requirements. The position manages key policy functions, evaluates Managed Care Organization (MCO) pharmacy performance, and reviews Pharmacy Benefits Administrator deliverables for alignment with Medicaid standards. It analyzes claims and utilization trends, supports 340B and Drug Rebate regulatory compliance, maintains benefit documentation, and drafts administrative rules and communications. The Program Planner 3 coordinates responses to complex inquiries, appeals, and regulatory requests; guides coding alignment activities; prepares leadership briefings; and works with legal, finance, data, program integrity, and other internal partners to resolve issues and support member and provider outcomes.
Requirements
- Meet at least one of the stated minimum qualification pathways: seven years of full-time experience administering or operating a program; or one year of such experience plus the specified combined education and experience totals; or graduation from an accredited school of law; or qualifying current, continuous state executive branch experience as a Program Planner 2 or Program Planner 1.
- Complete a background check to be considered.
- All work performed on behalf of Iowa Health and Human Services must occur in the State of Iowa.
Responsibilities
- Manage policy functions for the Physician Administered Drug (PAD) and Outpatient Prescribed Drug (OPD) benefits.
- Evaluate Managed Care Organization (MCO) pharmacy performance.
- Review Pharmacy Benefits Administrator deliverables to ensure alignment with Medicaid standards.
- Analyze claims and utilization trends.
- Support 340B and Drug Rebate regulatory compliance.
- Maintain accurate benefit documentation.
- Draft administrative rules and communications.
- Coordinate responses to complex inquiries, appeals, and regulatory requests.
- Guide coding alignment activities.
- Prepare briefings for leadership.
- Collaborate with legal, finance, data, program integrity, and other internal partners to resolve issues and support member and provider outcomes.
Benefits
- Competitive salary
- Health insurance coverage
- Dental insurance coverage
- Vision coverage
- Paid vacation, sick leave, and holidays
- IPERS retirement plan
- Retirement Investors Club (RIC) employer-sponsored retirement plan with state matching contributions
- Flexible spending accounts for medical and dependent care expenses
- Life insurance
- Free long-term disability insurance
- Employee Assistance Program
- Employee discount programs
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
