Workforce Classification:
Hybrid
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About the role of the Manager, Pharmacy Utilization Management
The Manager, Pharmacy Utilization Management is a newly created leadership role that brings together clinical expertise and operational leadership to help shape the future of Pharmacy Utilization Management (UM) at Premera. This role offers the opportunity to connect the department’s strategic direction with the evolving needs of its review operations, supporting a more unified approach across pharmacy benefit and medical benefit drugs. You’ll help position Pharmacy UM for its next phase as workforce models, workflows, and technology evolve.
What you’ll do:
Oversee day-to-day activities of the team, including staff management, achieving department goals and team effectiveness.
Ensure clinical programs, operations and consulting focus effectively delivers on the strategic direction of Premera's Pharmacy Program while meeting the needs of customers.
Develop and maintain monitoring and ongoing improvement strategy for pharmacy clinical programs, operations, or consulting. Areas of focus may include:
Drug Utilization Management/Prior Authorization across Medical and Pharmacy benefit
Quality accreditation reporting and documentation and required procedures for pharmacy.
Pharmacy benefit manager (PBM) and other vendor set-up, testing and issue resolution
Specialty pharmacy set-up, testing and escalated specialty pharmacy customer issues.
Formulary Program and Formulary Promotions, including oversight of Pharmacy and Therapeutics (P&T) Committee
Responsible for hiring, performance management, training, and professional development of team.
Provide clinical training, and business support of pharmacy and medical management strategies and solutions to Sales and Marketing Department including sales of the pharmacy benefit to clients (current and prospective clients)
Contribute to and manage completion of pharmacy and clinical/medical management content in Request for Proposals (RFPs).
Complete special projects and other duties as assigned.
As part of this role, you may be assigned internal controls derived from Premera’s internal controls framework. You will be accountable for understanding the controls assigned to you, their impacts on Premera, and to ensure that they are operating effectively.
What you’ll bring:
Pharmacist with an advanced degree (e.g. PharmD, MBA, MHA, MPH). (Required)
Active state Pharmacist License. (Required)
Six (6) years’ of pharmacy experience with at least two (2) years’ experience focused in any combination of the following: clinical program development, pharmacy consulting experience working in a Pharmacy Benefit Management (PBM) or in a health plan. (Required)
Completion of the American Society of Health-System Pharmacists ASHP-accredited residency program. (Preferred)
Experience with project management. (Preferred)
Experience in a managed care pharmacy. (Preferred)
Demonstrated ability to lead and manage multiple, complex, concurrent projects or teams.
Ability to communicate effectively verbally and in writing; strong presentation skills.
Proven ability to build and…