Coordinate the implementation and execution of medical drug strategy and management of the pre-determination process for specialty pharmacy. Drive biosimilar adoption, utilization pathways, clear/white bagging policies, specialty pharmacy partnerships, and sourcing strategies. Optimize infusion and specialty drug administration settings for cost savings and improved outcomes. Lead execution of CMS/state drug requirements across systems and providers, Part B Implementation. Lead QAI efforts for medical drug spend and utilization support cost containment and driving medical forecasting for consistent execution. Coordinate and collaborate with Pharmacy, Medical, Network, Finance, and Operations to ensure unified execution. Assist in the development of integrated service delivery to members and oversee data and processes to maintain industry standards and practices. Assist the Director in developing processes to manage appropriate utilization and assure appropriate payment for specialty/medical drug services and programs. Interact with providers and staff to manage benefits aligned with regulations, URAC and NCQA regulations and CareSource policies and vision. Oversee CQI (Continuous Quality Improvement) activities and document departmental processes for internal and external use. Review and revise workflows to maximize efficiencies. Monitor productivity and utilization trends. Regularly report all specialty pharmacy/medical drug data and program performance. Ensure compliance with and reporting of all regulatory requirements. Analyze and formulate recommendations based on data. Maintain and update all departmental policies and procedures. Act as liaison with other departments to assist with research and intervention. Perform any other job related duties as requested. Bachelor's degree in Pharmacy required or Doctorate of Pharmacy (Pharm.D.) required Five (5) years of experience in Managed Care required Three (3) years of Specialty Pharmacy/Medical Drug Management required Experience in data analysis and trending required Previous management experience preferred Advanced proficiency level with Microsoft Outlook, Work, Excel, and PowerPoint Knowledge of specialty pharmacy and medical drug management standards and practices Communication skills Management and prior supervisory skills Ability to work independently and within a team environment Attention to detail Familiarity of the health care field Critical listening and thinking skills Training/teaching skills Strategic management skills Negotiation skills Proper grammar usage Change resiliency Technical writing skills Time management skills Proper phone etiquette Customer service oriented Decision making/problem solving skills Leadership skills Unrestricted registered pharmacist (RPh) Licensure in state of practice required Ability to acquire pharmacist licensure in multiple states, as required General office environment; may be required to sit or stand for extended periods of time Travel is not typically required Compensation Range: CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package. Compensation Type (hourly/salary): Organization Level Competencies Fostering a Collaborative Workplace Culture Cultivate Partnerships Develop Self and Others Drive Execution Influence Others Pursue Personal Excellence Understand the Business