Senior Pharmacy Professional

This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a Senior Pharmacy Professional based in United States.

This role is a senior-level pharmacy claims and advisory position focused on improving care outcomes and operational efficiency within a Medicaid and FIDE SNP environment. It serves as a subject matter expert for pharmacy-related issues, supporting care management teams and ensuring accurate resolution of complex pharmacy claims and member concerns. The position plays a key role in analyzing utilization trends, improving processes, and ensuring compliance with regulatory and audit requirements across state and federal programs. It requires close collaboration with pharmacy benefit managers, care teams, and leadership to enhance service delivery and member experience. Acting as both a technical expert and strategic advisor, the role influences pharmacy policy, workflow design, and program performance. This is a highly autonomous position combining analytical expertise, clinical knowledge, and cross-functional coordination.

• Serve as the primary pharmacy subject matter expert supporting Medicaid and FIDE SNP programs, resolving complex pharmacy claims and member issues.
• Intake, investigate, and independently resolve pharmacy-related inquiries from care management teams, ensuring timely and accurate solutions.
• Lead pharmacy governance and coordination efforts, including facilitating steering committee meetings with internal and external stakeholders.
• Analyze pharmacy utilization data to identify trends, inefficiencies, and opportunities for process improvement and better member outcomes.
• Support audits, compliance reviews, and regulatory requirements at state and federal levels, ensuring adherence to applicable standards.
• Collaborate with pharmacy benefit managers, care management, and quality improvement teams to optimize workflows and member interventions.
• Develop pharmacy-related policies, training materials, and job aids to support operational consistency and knowledge sharing.
• Participate in transition and integration activities with pharmacy vendors, including data reconciliation and file transfers.

Requirements:

• Bachelor’s degree in pharmacy, healthcare administration, or related field.
• 2+ years of experience in pharmacy benefits management, pharmacy claims, or related healthcare operations.
• Strong analytical and problem-solving skills with experience in data-driven workflow or process improvement initiatives.
• Proficiency in MS Office tools including Excel, Word, PowerPoint, and Visio.
• Experience working within Medicaid, Medicare, or similar healthcare programs is highly preferred.
• Ability to interpret pharmacy utilization data and translate insights into actionable recommendations.
• Strong communication and collaboration skills with the ability to work across clinical, operational, and administrative teams.
• Experience participating in audits, compliance activities, or regulatory reporting is a plus.

Benefits:

• Competitive annual salary ranging from $71,100 to $97,800 depending on experience and qualifications.
• Performance-based bonus eligibility.
• Comprehensive medical, dental, and vision insurance coverage.
• 401(k) retirement savings plan with employer contributions.
• Paid time off including holidays, parental leave, and volunteer time off.
• Short-term and long-term disability coverage and life insurance.
• Remote work flexibility with occasional travel for meetings or training.
• Professional development opportunities within a large healthcare organization.