Clinical Pharmacy Medicare Specialist

Medica''s Clinical Pharmacy Medicare Specialist works in conjunction with key internal and external stakeholders to drive the strategy supporting the pharmacy-related components of our Medicare growth and affordability.Areas of focus include Part D formulary, utilization management, provider-administered medications (covered under Part B), clinical programs, and Medicare STARs initiatives. The incumbent will keenly anticipate key market events and incorporate into strategic recommendations in consideration with local or regional trends.Key Accountabilities:* Oversees and partners with key stakeholders in formulary management, clinical and quality programs, and regulatory and compliance needs* Monitoring and maintenance of product offerings, clinical program offerings, and trends within Medica''s competitive landscape, and creating recommendations on improving market competitiveness of Medica''s pharmacy programs* Leads regularly scheduled pharmacy/product team meetings to provide updates and discuss relevant strategy* Partners with internal stakeholders in preparing and presenting relevant content at quarterly business reviews and Accountable Care Organization meetings* Serves as Medicare pharmacy subject matter expert and advisor to the product teams* Actively participates in internal and external clinical pharmacy meetings necessary to support key accountabilitiesStrategic goals are focused on offering market competitive and member friendly formularies and clinical programs, enhancing pharmacy-related STARs initiatives, and collaborative development of success metrics to evaluate the performance of each program and initiative. The individual in this role will ensure that such work is done in compliance with applicable CMS regulations.It''s important that our Medicare Pharmacy Strategy Manager has a strong understanding of Medicare Part B and D requirements, Medicare STARs measures, the competitive landscape, the health plan space, PBM business practices, and vendor management. This position will need to effectively navigate a large health care organization and understand the unique needs of customers including members, providers, and internal peers.Qualifications:* Bachelor''s degree in Pharmacy required; PharmD preferred* 7+ years of related experience* Program management experience required* Previous Medicare Part D experience is required* Familiarity with Part B medication rules and requirements is helpful, however not required* Prior experience with regulated markets from a health plan or PBM standpoint is required* Experience working in a matrixed or multi-disciplinary environment is preferredCertifications/Licensure:* Valid, registered pharmacy license (in any state)Skills and Abilities:* Organized individual who can simultaneously balance and- execute through multiple projects and priorities* Self-starter, possessing willingness and ambition to work through ambiguity* Creative thinker* Motivated to problem solve* Ability to present to an executive audience* Collaborative, team-oriented spirit* Excellent written and verbal communication skills* Customer/patient focused* Operates with flexibility in changing business environment* Proven track record on consistently achieving desired results

Created: 2025-11-15