Manager, Medical Drug Strategy – Execution
CareSource
full-time
Posted on:
Location Type: Remote
Location: United States
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Salary
💰 $94,100 - $164,800 per year
About the role
- Coordinate the implementation and execution of medical drug strategy and management of the pre-determination process for specialty pharmacy.
- Drive biosimilar adoption, utilization pathways, clear/white bagging policies, specialty pharmacy partnerships, and sourcing strategies.
- Optimize infusion and specialty drug administration settings for cost savings and improved outcomes.
- Lead execution of CMS/state drug requirements across systems and providers, Part B Implementation.
- Lead QAI efforts for medical drug spend and utilization support cost containment and driving medical forecasting for consistent execution.
- Coordinate and collaborate with Pharmacy, Medical, Network, Finance, and Operations to ensure unified execution.
- Assist in the development of integrated service delivery to members and oversee data and processes to maintain industry standards and practices.
- Assist the Director in developing processes to manage appropriate utilization and assure appropriate payment for specialty/medical drug services and programs.
- Interact with providers and staff to manage benefits aligned with regulations, URAC and NCQA regulations and CareSource policies and vision.
- Oversee CQI (Continuous Quality Improvement) activities and document departmental processes for internal and external use.
- Review and revise workflows to maximize efficiencies.
- Monitor productivity and utilization trends.
- Regularly report all specialty pharmacy/medical drug data and program performance.
- Ensure compliance with and reporting of all regulatory requirements.
- Analyze and formulate recommendations based on data.
- Maintain and update all departmental policies and procedures.
- Act as liaison with other departments to assist with research and intervention.
- Perform any other job related duties as requested.
Requirements
- Bachelor's degree in Pharmacy required
- Five (5) years of experience in Managed Care required
- Three (3) years of Specialty Pharmacy/Medical Drug Management required
- Experience in data analysis and trending required
- Previous management experience preferred
Benefits
- Health insurance
- Retirement plans
- Paid time off
- Flexible work arrangements
- Professional development
- Bonuses
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
data analysismedical drug managementspecialty pharmacy managementcost containmentutilization managementinfusion optimizationregulatory complianceworkflow optimizationmedical forecastingcontinuous quality improvement
Soft Skills
collaborationleadershipcommunicationorganizational skillsproblem-solvinginterpersonal skillsstrategic thinkinganalytical skillsadaptabilityattention to detail
Certifications
Bachelor's degree in Pharmacy