Manager, Pharmacy Operations

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 Manager of Pharmacy Operations is responsible for the overall direction and management of pharmacy operations for Medica. This position develops solutions to streamline processes, reduce administrative costs and improve operational procedures; and directs the implementation of strategies to enhance the member experience and improve effectiveness. Performs other duties as assigned.

Key Accountabilities

• Process Improvement
  
  
  
  • Oversees accurate administration of Medica's prescription drug benefits and including accumulator and enrollment data exchange between vendors
  • Develops and oversees implementation of clinical and operational strategies, new programs and custom network development
  • Oversees pharmacy benefit and program implementation, communication and coordination across Medica's business units
  • Represent Pharmacy Operations at leadership level during meetings and presentations including the Pharmacy Executive Steering Committee
  • Partner with Sales and Account Management to address exceptions and customized requests to determine viability, effort, risks, costs and impact
  
  
  
  
• People Management
  
  
  
  • Manages day-to-day operational functions
  • Directs workflow, prioritization and strategic alignment of initiatives
  • Recruits, hires, coaches and oversees training of new team members
  • Conducts performance evaluations and promotes career development
  
  
  
  
• Vendor Management
  
  
  
  • Oversees PBM claim processing to ensure accuracy and timeliness
  • Holds PBM and mail order vendors accountable to contract provisions and performance guarantee standards
  • Manages quality controls (financial, procedural and compliance) for operational systems and processes
  • Oversees issue resolution with PBM and other vendors
  
  
  
  

Minimum Qualifications

• Bachelor's degree in Business, or equivalent experience in related field
• 5 years of equivalent work experience

Preferred Qualifications

• Leadership experience in pharmacy operations or managed care
• Knowledge of health care industry/products/benefits
• Experience in PBM vendor management
• Experience in medical pharmacy
• Advanced experience with MS Excel

This position is an Office role, which requires an employee to work onsite, on average, 3 days per week. We are open to candidates located near one of the following office locations: Minnetonka, MN, Madison, WI, Omaha, NE, St. Louis, MO.

The full salary grade for this position is $87,100 - $149,300. While the full salary grade is provided, the typical hiring salary range for this role is expected to be between $87,100 - $130,620. Annual salary range placement will depend on a variety of factors including, but not limited to, education, work experience, applicable certifications and/or licensure, the position's scope and responsibility, internal pay equity and external market salary data. In addition to compensation, Medica offers a generous total rewards package that includes competitive medical, dental, vision, PTO, Holidays, paid volunteer time off, 401K contributions, caregiver services and many other benefits to support our employees.

The compensation and benefits information is provided as of the date of this posting. Medica's compensation and benefits are subject to change at any time, with or without notice, subject to applicable law.

We are an Equal Opportunity employer, where all qualified candidates receive consideration for employment indiscriminate of race, religion, ethnicity, national origin, citizenship, gender, gender identity, sexual orientation, age, veteran status, disability, genetic information, or any other protected characteristic.