Medica
Overview
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Manager, Pharmacy Operations
role at
Medica .
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 are a team that owns our work with accountability, makes data-driven decisions, embraces continuous learning, and celebrates collaboration. Our mission is to be there in the moments that matter most for our members and employees, creating a community of connected care where coordinated, quality service is the norm and every member feels valued.
Key Accountabilities
Process Improvement
Oversees accurate administration of Medica’s prescription drug benefits, 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 levels 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 guarantees
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 education, work experience, applicable certifications and/or licensure, the position’s scope and responsibility, internal pay equity and external market salary data. Medica offers a generous total rewards package that includes competitive medical, dental, vision, PTO, Holidays, paid volunteer time off, 401K contributions, caregiver services and other benefits.
The compensation and benefits information is provided as of the posting date and is 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 regardless of race, religion, ethnicity, national origin, citizenship, gender, gender identity, sexual orientation, age, veteran status, disability, genetic information, or any other protected characteristic.
Job Details
Seniority level: Mid-Senior level
Employment type: Full-time
Job function: Management and Manufacturing
Industries: Insurance
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Manager, Pharmacy Operations
role at
Medica .
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 are a team that owns our work with accountability, makes data-driven decisions, embraces continuous learning, and celebrates collaboration. Our mission is to be there in the moments that matter most for our members and employees, creating a community of connected care where coordinated, quality service is the norm and every member feels valued.
Key Accountabilities
Process Improvement
Oversees accurate administration of Medica’s prescription drug benefits, 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 levels 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 guarantees
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 education, work experience, applicable certifications and/or licensure, the position’s scope and responsibility, internal pay equity and external market salary data. Medica offers a generous total rewards package that includes competitive medical, dental, vision, PTO, Holidays, paid volunteer time off, 401K contributions, caregiver services and other benefits.
The compensation and benefits information is provided as of the posting date and is 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 regardless of race, religion, ethnicity, national origin, citizenship, gender, gender identity, sexual orientation, age, veteran status, disability, genetic information, or any other protected characteristic.
Job Details
Seniority level: Mid-Senior level
Employment type: Full-time
Job function: Management and Manufacturing
Industries: Insurance
Sign in to set job alerts for “Pharmacy Operations Manager” roles.
#J-18808-Ljbffr