Senior Consultant, Medicare Part D Pharmacy

Gallagher•Rolling Meadows, IL

About The Position

Join Gallagher as a Senior Consultant specializing in Medicare Part D Pharmacy. In this role, you’ll provide expert consulting support to help clients navigate Medicare Part D operations, formulary administration, and regulatory compliance. You’ll partner with clients and internal teams to design, optimize, and maintain pharmacy programs that align with CMS requirements and deliver sustainable results. This is a dynamic role where your expertise will drive operational excellence and improve plan performance.

Requirements

Working knowledge of Part D claims adjudication and Prescription Drug Event (PDE) processing to support plan operations, issue identification, and regulatory compliance.
Bachelor’s degree or Doctor of Pharmacy (PharmD) required; active Pharmacist license required.
Minimum of 10 years of experience in healthcare, government programs, PBM operations, compliance, quality, or related fields.
Extensive experience with Medicare Part D plan operations, formulary development and administration, and P&T Committee processes.
Strong knowledge of Medicare and/or Medicaid regulatory standards.
Advanced proficiency in Microsoft Word, Excel, Access, and PowerPoint.
Ability to communicate complex regulatory and operational concepts clearly to internal and external stakeholders.
Strong organizational, analytical, and problem-solving skills with the ability to work independently and manage multiple priorities under tight timelines.

Nice To Haves

Experience with PACE plans and/or 340B programs.
Experience with Medicaid and Exchange pharmacy operations and regulations.
Experience supporting Medicare Star Ratings pharmacy measures, including medication adherence and quality improvement initiatives.
Familiarity with Medication Therapy Management (MTM) program design, operations, or performance monitoring within Medicare Part D.
Advanced degree or professional certification in pharmacy, compliance, audit, or a related discipline.

Responsibilities

Serve as a subject matter expert in Medicare Part D plan and pharmacy operations, with emphasis on formulary development, administration, and benefit design.
Provide strategic and operational guidance on formulary management, including CMS requirements, submission processes, and ongoing maintenance.
Support Pharmacy & Therapeutics (P&T) Committee activities, including governance, documentation, regulatory compliance, and operational execution.
Advise on plan-level operational processes impacting formulary administration, utilization management, and beneficiary access.
Support CMS Program Audits with a primary focus on Formulary Administration and Coverage Determinations, Appeals, and Grievances (CDAG).
Develop, update, and maintain policies, procedures, and work plans related to Part D plan and formulary operations.
Oversee and administer ongoing monitoring programs to ensure continued compliance with CMS guidance.
Monitor and guide implementation of corrective action plans, ensuring sustainable operational and regulatory outcomes.
Mentor team members and guide work products using structured project management methodologies.
Manage client communications, expectations, and deliverables while providing high-quality consultative service.
Support client interim staffing needs as required.
Travel as required to support client engagements.

Benefits

Medical/dental/vision plans, which start from day one!
Life and accident insurance
401(K) and Roth options
Tax-advantaged accounts (HSA, FSA)
Educational expense reimbursement
Paid parental leave
Digital mental health services (Talkspace)
Flexible work hours (availability varies by office and job function)
Training programs
Gallagher Thrive program – elevating your health through challenges, workshops and digital fitness programs for your overall wellbeing
Charitable matching gift program