Pharmacy Solutions Manager

This is a fully remote position, open to applicants in Florida.

📋 Description

• Oversee the onboarding and establishment of pharmacies owned or affiliated with the Health System, which includes managing participation records, credentialing documentation, system configurations, and communications related to Payment-Remit setups.

• Ensure the accuracy of pharmacy data and setup through rigorous quality checks and audits, addressing any discrepancies that may impact claims, payments, or reporting.

• Facilitate communications with pharmacy partners, while collecting and maintaining necessary pharmacy records, agreements, and correspondence.

• Address escalated issues related to pharmacy participation and communication, acting as a reliable point of contact for pharmacy partners.

• Engage in implementation meetings to convey timelines, tackle problems, raise questions, and share relevant information.

• Contribute to the development, launch, and ongoing management of specialized pharmacy programs and communications with providers.

• Assist with network strategy, responses to RFPs, new client implementations, and analyses related to access, gaps, and disruptions.

• Collaborate with Clinical, Operations, Account Management, and Network teams throughout the client lifecycle.

• Create Standard Operating Procedures (SOPs), workflows, job aids, and internal training resources; implement improvements in processes.

• Generate pharmacy-specific reports and actionable insights regarding participation, performance, and the impact of programs.

• Monitor department ticket queues, service levels, and guarantee items, while identifying risks and driving corrective measures.

• Ensure compliance with regulatory, contractual, and HIPAA standards; report any HIPAA violations and complete necessary HIPAA training.

• Provide leadership and oversight for the department, including management of managers and directors.

• Willingness to travel approximately 30% of the time.

⛳️ Requirements

• Current pharmacist licensure.

• Doctor of Pharmacy (PharmD) degree.

• At least seven years of progressively responsible experience in pharmacy network operations, PBM operations, managed care, healthcare compliance, regulatory affairs, audit management, or similar fields.

• A minimum of two years of relevant experience within a PBM environment.

• Experience in a hospital health system.

• Background in managing regulatory submissions, audits, corrective action plans, compliance monitoring, or responding to regulators.

• Demonstrated ability to work collaboratively with Legal, Compliance, Operations, IT, Network, and senior leadership teams.

• Strong project management and organizational skills.

• Technical proficiency.

• Effective problem-solving and analytical capabilities.

• Excellent written and verbal communication skills.

• Ability to learn independently.

• Experience in cross-functional collaboration.

• Skills in program and process development and oversight.

• Availability to work core hours from 8:00 AM to 5:00 PM CT, with flexibility for meetings across different time zones.

• Willingness to work extended hours, weekends, and holidays as required by the industry.

• Preferred: Bachelor’s degree in a relevant field.

• Preferred: Two years of experience in a healthcare-related field.

• Preferred: Two years of experience in business analysis.

• Preferred: An advanced degree such as an MBA, MHA, PharmD, JD, or related graduate degree.

• Preferred: Certification in healthcare compliance, pharmacy technician, or a similar professional certification.

• Strongly preferred: Experience in PBM, health plans, managed care, pharmacy networks, or with regulatory bodies.

• Preferred: Leadership experience in developing or enhancing compliance programs, audit processes, tracking tools, or governance frameworks.

🏝️ Benefits

• Medical, Dental, and Vision Insurance.

• Disability and Life Insurance.

• Employee Assistance Program.

• Remote work options.

• Generous Paid Time Off.

• Annual performance reviews and development plans.

• Retirement Plan with immediate company match, fully vested.