Senior Pharmacy Manager, Utilization Management

Position Overview

At Devoted Health, we are dedicated to improving the health and well-being of older Americans by providing comprehensive, integrated healthcare solutions. We are seeking a highly motivated and experienced Senior Pharmacy Manager of Utilization Management to lead our pharmacy benefit strategies. This role is crucial in ensuring appropriate medication use, optimizing therapeutic outcomes, and managing a team of dedicated professionals. You will work closely with providers nationwide to streamline communication and ensure transparent, timely decisions on coverage, while collaborating with various internal teams to align operations with regional strategies and regulatory requirements.

Employment Type

Full-time

Location Type

To be specified

Salary

To be specified

Responsibilities and Impact

• Lead a team of clinical pharmacists and pharmacy technicians responsible for utilization management decision-making and member/provider support for Medicare Part B drugs and relevant durable medical equipment.
• Develop and oversee drug policy criteria, utilizing clinical evidence, rebate analytics, and formulary strategy to ensure appropriate, cost-effective access to medications.
• Build and refine communication strategies with providers to ensure clarity, transparency, and efficiency in coverage decisions, including provider education on preferred products and prior authorization requirements.
• Collaborate with regional Network teams to ensure alignment of pharmacy utilization strategies with local provider relationships, clinical goals, and state-specific regulations.
• Partner with analytics, medical, and product teams to design data-driven workflows that surface performance trends and utilization opportunities for timely intervention.
• Support rebate optimization efforts by aligning prior authorization strategies with preferred product access, financial goals, and market shifts.
• Monitor evolving CMS guidance and ensure utilization management practices meet regulatory requirements and audit standards.
• Lead operations for offshore clinical partners who assist in workflows.
• Participate in a mandatory weekend on-call rotation.

Required Skills and Experience

• PharmD or equivalent advanced degree in pharmacy.
• Minimum of 4-6 years of experience in pharmacy utilization management (Part B Drugs & Biologics), Medicare, or health plan strategy roles.
• Strong working knowledge of Medicare Part B and D regulations, CMS audit protocols, and pharmacy benefit design.
• Proven ability to lead cross-functional initiatives using data to drive operational and strategic improvements.
• Exceptional written and verbal communication skills, with the ability to synthesize clinical, regulatory, and financial insights into actionable decisions.
• Excellent analytical skills with the ability to manage and interpret large datasets, including proficiency in Google Sheets.

Desired Skills and Experience

• Ability to thrive in a fast-paced, startup environment.
• Strong attention to detail and organizational skills.
• Ability to manage multiple priorities and understand urgency.
• Proven problem-solving abilities.

Company Information

At Devoted Health, our mission is to dramatically improve the health and well-being of older Americans by caring for every person like family. We are building a new kind of all-in-one healthcare company that integrates compassion, health insurance, clinical care, service, and technology. Founded in 2017, we have experienced rapid growth and now serve members across the United States. Join us on our mission!

Application Instructions

To be specified