Senior Pharmacy Professional

About the role

This senior‑level position focuses on pharmacy claims and advisory services within Medicaid and FIDE SNP programs in the United States. The role acts as the primary subject‑matter expert, supporting care management teams, resolving complex pharmacy issues, and driving improvements in care outcomes and operational efficiency.

Key responsibilities

• Serve as the lead pharmacy expert for Medicaid and FIDE SNP programs, handling complex claims and member concerns.
• Investigate, intake, and independently resolve pharmacy‑related inquiries from care management teams.
• Lead pharmacy governance activities, including steering committee facilitation with internal and external stakeholders.
• Analyze utilization data to identify trends, inefficiencies, and opportunities for process improvement.
• Support audits, compliance reviews, and regulatory requirements at state and federal levels.
• Collaborate with pharmacy benefit managers, care management, and quality improvement teams to optimize workflows.
• Develop policies, training materials, and job aids for consistent operational practices.
• Participate in vendor transition and integration activities, including data reconciliation.

Required profile

• Bachelor’s degree in pharmacy, healthcare administration, or a related field.
• At least 2 years of experience in pharmacy benefits management, pharmacy claims, or related healthcare operations.
• Strong analytical and problem‑solving abilities with a data‑driven mindset.
• Experience working within Medicaid, Medicare, or similar programs is highly preferred.
• Excellent communication and collaboration skills across clinical, operational, and administrative teams.

Required skills

• Proficiency in Microsoft Excel
• Proficiency in Microsoft Word
• Proficiency in Microsoft PowerPoint
• Proficiency in Microsoft Visio