[Hiring] Supervisor, Pharmacy Benefits and Formulary @SCAN Health Insurance

Role Description

This position provides leadership and oversight of formulary management, pharmacy benefits, and Part D program implementation for a senior-focused Medicare Advantage organization. The Supervisor leads the Formulary and Benefits team and oversees:

• Formulary management
• Benefit administration
• PBM operations and performance
• Utilization management
• Transition program
• P&T Committee activities
• Pharmacy networks
• Related member and other marketing materials across all business lines

The role ensures CMS regulatory compliance, operational excellence, and enhanced member experience while supporting the organization's mission, Part D cost management, growth, and profitability. The Supervisor also monitors industry trends, regulatory changes, and best practices to drive continuous improvement and effective pharmacy benefit management.

Qualifications

• Graduate or Advanced Degree, Pharm D required
• Active Pharmacist License required
• Completion of a PGY1 and/or PGY2 residency or equivalent clinical practice experience preferred
• Demonstrated knowledge of and experience monitoring Medicare Part D regulations, required
• 5+ years or more of managed care pharmacy experience; or equivalent experience in a managed care setting, strongly preferred
• 1-2 years leadership/management experience strongly preferred
• Knowledge and experience with organizing quality improvement initiatives and presenting findings to leadership
• Exceptional verbal, written, and interpersonal communication skills
• High commitment to professionalism and customer service
• Computer proficiency required to perform essential job functions

Requirements

• Lead and support CMS Part D program audits, One-Third Financial audits, Data Validation Audits and other CMS’s regulatory audits
• Manage audit universe files; including HPMS reporting requirements and ensure ongoing audit readiness through mock audits, compliance monitoring, and post-submission reviews
• Lead the Pharmacy Benefits and Formulary team for compliance and effectiveness
• Oversee cap deduct activities and issue resolution
• Implement new CMS programs and process enhancements that strengthen compliance, efficiency, and member experience
• Ensure AEP (annual election period) and 1/1 readiness across applicable operational areas
• Serve as subject matter expert for Part D Formulary, Inflation Reduction Act, Maximum Fair Price Drugs, Medicare Prescription Payment plan program
• Oversee development and implementation of Part D Utilization Management criteria and other quality controls
• Identify and implement responsible uses of AI, automation, and other tools to reduce manual reporting
• Provide supervision, development, and coaching to pharmacists, technicians, and support staff
• Supervises/Manages Others (i.e. hires, performance reviews, corrective action, etc.)
• Actively support the achievement of SCAN’s Vision and Goals
• Other duties as assigned

Benefits

• Base salary range: $125,400 to $181,419 per year
• Work Mode: Remote
• An annual employee bonus program
• Robust Wellness Program
• Generous paid-time-off (PTO)
• 11 paid holidays per year, plus 1 floating holiday, plus 1 birthday holiday
• Excellent 401(k) Retirement Saving Plan with employer match and contribution
• Robust employee recognition program
• Tuition reimbursement
• An opportunity to become part of a team that makes a difference to our members and our community every day!