Sr. Manager, Pharmacy

United States

Apply with AI Apply

Not SpecifiedCompensation

Expert & Leadership (9+ years)Experience Level

Full TimeJob Type

UnknownVisa

Health Insurance, Healthcare, PharmacyIndustries

Requirements

Candidates must possess a PharmD or equivalent advanced degree in pharmacy and have 4-6 years of experience in pharmacy utilization management, specifically with Medicare Part B drugs and biologics, or in health plan strategy roles. A strong understanding of Medicare Part B and D regulations, CMS audit protocols, and pharmacy benefit design is essential, along with proven experience leading cross-functional initiatives using data for improvements. Exceptional written and verbal communication, as well as strong analytical skills with proficiency in Google Sheets, are required.

Responsibilities

The Senior Pharmacy Manager will lead a team responsible for utilization management decision-making and member/provider support for Medicare Part B drugs and related durable medical equipment. This role involves developing and overseeing drug policy criteria, building provider communication strategies for coverage decisions, and collaborating with network, clinical, and compliance teams to align pharmacy utilization strategies with regional needs and regulations. Responsibilities also include partnering with analytics and product teams to design data-driven workflows, supporting rebate optimization, monitoring CMS guidance for regulatory compliance, and leading offshore clinical partners. A mandatory weekend on-call rotation is also part of the role.

Skills

Pharmacy Benefit Strategies

Utilization Management

Drug Policy Criteria

Clinical Evidence

Rebate Analytics

Formulary

Medicare Part B Drugs

Durable Medical Equipment

Team Leadership

Clinical Operations

Provider Engagement

Regulatory Compliance

Devoted Health

Medicare Advantage plans with personalized support

About Devoted Health

Devoted Health provides Medicare Advantage plans aimed at simplifying and making healthcare more affordable for seniors aged 65 and older. Their plans include services like provider and pharmacy searches, prescription drug coverage, and preventive care rewards. Members pay premiums for these plans, and the company may also receive government payments for managing Medicare benefits. What sets Devoted Health apart from competitors is their high level of customer service, featuring Devoted Health Guides who assist members in navigating their healthcare options and addressing common issues with traditional insurance. Additionally, they promote preventive care through the Devoted Dollars program, which rewards members for engaging in health activities. The goal of Devoted Health is to create a more compassionate and accessible healthcare experience for its members.

Waltham, MassachusettsHeadquarters

2017Year Founded

$2,194.5MTotal Funding

SERIES_ECompany Stage

HealthcareIndustries

1,001-5,000Employees

Benefits

Comprehensive health plan

401(k) retirement plan

Generous vacation and holiday time

Lyra mental health resources

Time off to vote

Risks

Increased competition from Medicare Advantage providers like Clover Health and Oscar Health.

Potential regulatory changes affecting Medicare Advantage plans by CMS.

Rising healthcare costs could impact the affordability of Devoted Health's plans.

Differentiation

Devoted Health offers personalized assistance through Devoted Health Guides for member support.

The company emphasizes preventive care with its Devoted Dollars rewards program.

Devoted Health integrates virtual and in-home care with top local providers.

Upsides

Devoted Health raised $287 million in Series E funding in 2024.

The company expanded Medicare Advantage plans to eight new states in 2023.

Devoted Health achieved a 5-star Medicare Advantage rating in Ohio in 2023.

Land your dream remote job 3x faster with AI

Try Jobo Free