Health Plan Pharmacist – Program Manager - Pharmacy - Southwestern Health Resources (SWHR)

Education

• Bachelor's Degree in Pharmacy required.
• Doctor of Pharmacy or Pharm D. highly preferred.

Experience

• Require 2 years of Managed Care Pharmacy experience or Pharmacy Residency/educational experience which would provide an equivalent background.
• Prefer 1 year of Medicare Part D Health Plan experience.

Licenses and Certifications

• Pharmacist license from Texas State Board of Pharmacy upon hire is required.

Skills & Abilities

• Exceptional attention to detail and strong analytical/critical thinking skills.
• Experience with pharmacy data and analytics preferred.
• Knowledgeable in Medicare Part D rules and regulations.
• Advanced computer literacy including knowledge of Microsoft Office Suite.
• Excellent oral and written communication skills.
• Highly motivated with excellent time management skills and the ability to work independently with minimal supervision.
• High level of professionalism.

Position Responsibilities

The Pharmacist Program Manager – Care ‘N Care Health Plan will be responsible for managing the day-to-day operations of the Medicare Part D health plan. This includes oversight and monitoring of the Pharmacy Benefit Manager to ensure that the health plan is fully compliant with CMS rules and regulations. Areas of oversight include but are not limited to: coverage determinations, redeterminations, grievances, formulary administration, and clinical programs. Other responsibilities include assisting the Director in development and coordination of health plan clinical programs to improve and maintain STARs and HEDIS measures and assisting the Director in CMS-related audits.

Position Functions

• Direct the coverage determinations, appeals and grievances (CDAG) process which includes providing clinical decision support and oversight of PBM CDAG activities.
• Direct the claims rejects oversight process which includes providing clinical support and review of rejects when appropriate.
• Provide audit and monitoring support for Part D operations including CMS-related audits and PBM oversight monitoring.
• Collaborate with internal and external staff to develop and operationalize programs to improve and maintain key STARs and HEDIS measures.
• Participate in member and provider outreach and education.
• Assist the Director in development and coordination of health plan clinical programs.

Why Southwestern Health Resources 

As a Southwestern Health Resources employee, you’ll enjoy, comprehensive benefits, including a 401(k) with match; paid time off; competitive health insurance choices; healthcare and dependent care spending account options; wellness programs to keep you and your family healthy; tuition reimbursement; a student loan repayment program; and more.

Additional perks of being an SWHR employee:

• Gain a sense of accomplishment by contributing to a teamwork environment.
• Positively impact patients’ quality of life.
• Receive excellent mentorship, comprehensive training and dedicated clinical and administrative leadership resources.
• Enjoy opportunities for growth.

Explore Southwestern Health Resources Careers for more information and to search all career opportunities.

Our Recruitment team invites you to contact us with any questions at recruitment@texashealth.org