[Hiring] Senior Consultant, Medicare Part D Pharmacy @Gallagher

Role Description

Join Gallagher as a Senior Consultant specializing in Medicare Part D Pharmacy. In this role, you’ll provide expert consulting support to help clients navigate Medicare Part D operations, formulary administration, and regulatory compliance. You’ll partner with clients and internal teams to design, optimize, and maintain pharmacy programs that align with CMS requirements and deliver sustainable results. This is a dynamic role where your expertise will drive operational excellence and improve plan performance.

As a trusted advisor, you’ll:

• Serve as a subject matter expert in Medicare Part D plan and pharmacy operations, with emphasis on formulary development, administration, and benefit design.
• Provide strategic and operational guidance on formulary management, including CMS requirements, submission processes, and ongoing maintenance.
• Support Pharmacy & Therapeutics (P&T) Committee activities, including governance, documentation, regulatory compliance, and operational execution.
• Advise on plan-level operational processes impacting formulary administration, utilization management, and beneficiary access.
• Support CMS Program Audits with a primary focus on Formulary Administration and Coverage Determinations, Appeals, and Grievances (CDAG).
• Develop, update, and maintain policies, procedures, and work plans related to Part D plan and formulary operations.
• Oversee and administer ongoing monitoring programs to ensure continued compliance with CMS guidance.
• Monitor and guide implementation of corrective action plans, ensuring sustainable operational and regulatory outcomes.
• Mentor team members and guide work products using structured project management methodologies.
• Manage client communications, expectations, and deliverables while providing high-quality consultative service.
• Support client interim staffing needs as required.
• Travel as required to support client engagements.

Qualifications

• Working knowledge of Part D claims adjudication and Prescription Drug Event (PDE) processing to support plan operations, issue identification, and regulatory compliance.
• Bachelor’s degree or Doctor of Pharmacy (PharmD) required; active Pharmacist license required.
• Minimum of 10 years of experience in healthcare, government programs, PBM operations, compliance, quality, or related fields.
• Extensive experience with Medicare Part D plan operations, formulary development and administration, and P&T Committee processes.
• Strong knowledge of Medicare and/or Medicaid regulatory standards.
• Advanced proficiency in Microsoft Word, Excel, Access, and PowerPoint.
• Ability to communicate complex regulatory and operational concepts clearly to internal and external stakeholders.
• Strong organizational, analytical, and problem-solving skills with the ability to work independently and manage multiple priorities under tight timelines.

Requirements

• Experience with PACE plans and/or 340B programs.
• Experience with Medicaid and Exchange pharmacy operations and regulations.
• Experience supporting Medicare Star Ratings pharmacy measures, including medication adherence and quality improvement initiatives.
• Familiarity with Medication Therapy Management (MTM) program design, operations, or performance monitoring within Medicare Part D.
• Advanced degree or professional certification in pharmacy, compliance, audit, or a related discipline.

Benefits

• Medical/dental/vision plans, which start from day one!
• Life and accident insurance
• 401(K) and Roth options
• Tax-advantaged accounts (HSA, FSA)
• Educational expense reimbursement
• Paid parental leave
• Digital mental health services (Talkspace)
• Flexible work hours (availability varies by office and job function)
• Training programs
• Gallagher Thrive program – elevating your health through challenges, workshops and digital fitness programs for your overall wellbeing
• Charitable matching gift program
• And more...