Health Plan Pharmacy Program Manager

This community-based Health Plan in the San Francisco Bay Area is actively interviewing for a Pharmacy Manager to oversee the Pharmacy Program and Health Management operations. Apply today, and discover a stable work environment where you can make an actual difference in people’s lives every day.

Reporting to the Health Plan’s Medical Director, and working in close collaboration with Utilization and Operations Leaders, the Pharmacy Program Manager will play an integral role in how the organization serves its members. This Manager will also work with Physicians, Network Providers and Administrators, Pharmacists (Inpatient, Ambulatory, and Retail), Coders, and Health Plan Administrative Staff. Strong communication skills and an attitude of shared progress will be great characteristics for someone to step into this role successfully. 

As a licensed pharmacist, this person will be expected to offer clinical guidance and expertise, in addition to managing the administrative and professional operations of this business unit. Extensive experience in the Managed Care field, along with operational experience in Health Plan or Physician Group models will also be required for the Pharmacy Program Manager to excel in this position.

Overseeing around 5 Pharmacy Benefit Techs and support staff, the Health Plan Pharmacy Program Manager will deploy additional skills and experience to succeed, including:

  • Strong leadership and mentorship abilities, as well as experience in a supervisory capacity.
  • Working familiarity of CMS and ACA risk adjustment models, clinical documentation improvement concepts, coding processes, and physician incentive programs.
  • Experience developing prior authorization criteria and recommendations for Pharmacy Benefits coverage (as well as formulary alternatives), Medicare Part D formularies, as well as Commercial and Exchange produces.
  • Understanding and experience overseeing Medication Therapy Management (MTM) programs, working with Utilization / Care Management teams to ensure adequate delivery, and leading CMS reporting on results of programs.
  • The Manager should also have an excellent understanding of the current and evolving trend in laws and regulations regarding health plan / healthcare delivery and risk adjustment, as well as industry best practices.

This integrated health system has served the San Francisco community for over 50 years. The Manager of Pharmacy Program and Health Management will discover an amazing team of clinical and administrative leaders with quality patient care at their very heart. The hospital facility and its satellite clinics have been recognized by The Joint Commission and by the people of the community for its high-quality outcomes and superior patient care. A large part of this comes from the close connection this health system, its Health Plan, and the medical group have with the people it serves.

Those who are new to the San Francisco Bay Area and those who’ve lived there for years, each discover the same thing: it has something for everyone! No matter what direction you travel, great things await. A drive North will put the Health Plan Pharmacy Program Manager in the middle of California Wine Country, with all the beautiful vistas and multi-colored orchards. An hour west and you’re in the heart of San Francisco, where haute cuisine, world-class theater, and all manner of nightlife await. South and East take you to long hikes, large open skies, as many outdoor activities as you could want. Nearly anywhere you settle, you’ll find some of America’s top schools, a community of compassionate neighbors, and fantastic weather.

The Pharmacy Program Manager will play a direct role in realizing the Health Plan’s growth and development plans. You’ll get the opportunity to work with a wide array internal and external partners, driving the health system’s mission with every decision. For the dedication and hard work that this role will require, the Manager will receive a generous benefits package, a competitive compensation package including a strong commission structure based on performance, and the job security that comes with a growing and healthy organization.