Manager, Clinical Pharmacy Operations

CareSource

Manager overseeing Clinical Pharmacy operations ensuring consistent service delivery and utilization targets. Collaborate with teams, manage staff and drive efficiencies in healthcare services.

Posted 5/22/2026full-timeRemote • 🇺🇸 United StatesMid-LevelSenior💰 $113,000 - $197,700 per yearWebsite

About the role

Key responsibilities & impact

Responsible for oversight of all Clinical Pharmacy activities ensuring consistency in delivery of services and achievement of utilization targets
Assist in coordination and management of the pre-determination process for specialty pharmacy
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 services
Interact with providers and staff to manage benefits aligned with regulations, URAC and NCQA regulations and CareSource policies and vision
Review and revise workflows to maximize efficiencies
Monitor productivity and utilization trends
Oversee CQI activities and ensure audits and staff feedback occur at regular intervals
Regularly report all specialty pharmacy data
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
Empower staff to achieve goals
Coach, develop, and motivate team
Foster positive working relationships with internal departments and external providers
Perform any other job related instructions as requested

Requirements

What you’ll need

Bachelor of Arts or Bachelor of Science in health related field, science or math related field or equivalent work experience is required
Degree in pharmacy (RPh) or Bachelor of Science in Nursing (BSN) is preferred
Three to five years’ experience in Managed Care/Medicaid is required
Three to five years in Specialty Pharmacy Utilization is required
One to two years of experience in Case Management or home health care is preferred
Intermediate proficiency level with Microsoft Outlook, Work, Excel, and PowerPoint
Experience in data analysis and trending
Knowledge of care management standards and practices
Critical listening and thinking skills
Proper grammar usage

Benefits

Comp & perks

Comprehensive total rewards package
Bonus tied to company and individual performance

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

data analysisutilization managementworkflow optimizationclinical pharmacy oversightcase managementspecialty pharmacy utilizationcompliance reportingpolicy developmentauditingtrend analysis

Soft Skills

coachingteam developmentinterpersonal skillscommunicationleadershipproblem-solvingcritical thinkingrelationship buildingmotivationempowerment

Certifications

Bachelor of ArtsBachelor of ScienceRegistered Pharmacist (RPh)Bachelor of Science in Nursing (BSN)