Pharmacy Manager, Medical Pharmacy

Medica is a nonprofit health plan with more than a million members that serves communities in Minnesota, Nebraska, Wisconsin, Missouri, and beyond. We deliver personalized health care experiences and partner closely with providers to ensure members are genuinely cared for.

We're a team that owns our work with accountability, makes data-driven decisions, embraces continuous learning, and celebrates collaboration - because success is a team sport. It's our mission to be there in the moments that matter most for our members and employees. Join us in creating a community of connected care, where coordinated, quality service is the norm and every member feels valued.

The Pharmacy Manager, Medical Pharmacy is a member of the pharmacy leadership team. The incumbent has responsibility and accountability for overseeing the medical pharmacy clinical, financial, and operational strategy for all business segments including IFB, Commercial, Medicaid and Medicare. Key accountabilities include, but are not limited to, leading medical pharmacy policy development and utilization management for all segments, new medical drug clinical assessment and management strategy;

and oversight for both internal and delegated medical pharmacy management services. This will include navigating cross-functional processes and systems both within and external to the organization. Performs other duties as assigned.

• Provides oversight and support for all aspects of the medical pharmacy benefit, including elements such as drug policies, clinical services, operational processes and utilization management.
• Develops and implements strategies to manage medical drug costs and improve member outcomes consistent across all segments and markets.
• Prepares and presents medical drug reviews at Medica's formal approval committee.
• Reviews and analyzes medical drug utilization data to ensure optimal usage of medications.
• Ensures access to cost-effective medical drugs for our customers.
• Develops and implements medical pharmacy policies and procedures.
• Ensures compliance with regulatory standards across all segments and markets.
• Ensures the efficient and effective delivery of medical pharmacy services for customers.
• Represents medical pharmacy services and actively participates in both internal and external cross-functional meetings.
• Maintains up-to-date knowledge of new drugs, therapeutic trends, and healthcare laws and regulations.
• Maintains accurate and current records of all medical pharmacy decisions and changes.
• Addresses inquiries and disputes related to medical pharmacy authorization decisions.
• Identifies areas of operational improvements for medical pharmacy management.

• Oversees day-to-day processes associated with maintaining medical pharmacy services. Facilitates identification and resolution of barriers so that internal and vendor-delegated programs are implemented and functioning in a high quality, timely, and compliant manner.
• Provides leadership, development, guidance, recognition and oversight of direct reports.
• Serves as a mentor to staff with a set of goals and objectives that are clear and results-oriented.
• Coordinate workload, prioritization, and resource allocation to ensure timely delivery of clinical deliverables.
• Support knowledge development, standard work, and process improvement within the medical pharmacy function.
• Hires, develops, trains and retains high quality staff.
• Fosters a collaborative, value-driven team culture of high standards and strong productivity.
• Develops and maintains positive relationships with Medica leaders, key vendors, and colleagues within the pharmaceutical industry.
• Serve as a clinical escalation point for complex or high-risk…