Manager, Pharmacy Policy

Posted 2024-11-20

💎 Seniority level: Manager, 4+ years of experience with UM reviews, 4+ years of experience with clinical research, policy development, and/or medical writing, 3+ years of experience in Excel

📍 Location: Alabama, Arizona, California, Colorado, Connecticut, Florida, Georgia, Illinois, Indiana, Iowa, Kansas, Kentucky, Maine, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Oregon, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas, Utah, Vermont, Virginia, Washington, Washington, D.C.

💸 Salary: 131200 - 172200 USD per year

🔍 Industry: Health insurance

🏢 Company: Oscar Health

⏳ Experience: 4+ years of experience with UM reviews, 4+ years of experience with clinical research, policy development, and/or medical writing, 3+ years of experience in Excel

🪄 Skills: LeadershipMicrosoft ExcelAttention to detailOrganizational skillsPresentation skillsTime ManagementWritten communication

Requirements:

PharmD degree.
Active, unrestricted pharmacist license.
4+ years of experience with UM reviews.
4+ years of experience with clinical research, policy development, and/or medical writing.
3+ years of experience in Excel.
Bonus: Experience with CVS portal, fast-paced collaborative environments, residency training completed from accredited ASHP or AMCP programs.

Responsibilities:

Be accountable for the end-to-end process for development and review of pharmacy and medical drug guidelines.
Lead a team of contracted and/or matrixed reports to ensure timely review and submission of guideline updates.
Draft, obtain approval, and maintain pharmaceutical and medical drug policies based on clinical evidence.
Manage direct, contracted, and matrixed team members.
Ensure processes and policies adhere to departmental strategy.
Prepare and present materials for executive review, summarizing changes and tracking advancements.
Conduct high-complexity reviews requiring extensive industry expertise.
Partner with vendors for pharmacy code edit accuracy in claims systems.
Maintain subject matter expertise on pharmaceutical trends and evidentiary standards.
Comply with State, Federal, and NCQA requirements and provide support for regulatory audits.

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