Manager Clinical Pharmacy Quality and Affordability Programs

Manager Clinical Pharmacy Quality and Affordability Programs Hybrid role (3 days/week in office) at our Burlington, Renton, Spokane, Vancouver, Portland, Medford, Salt Lake City, Boise, Lewiston, Fargo offices. Preference will be given to current employees and candidates who reside within a commutable distance from our Salt Lake City, Boise, Fargo and Lewiston offices or who are willing to relocate.   Build a career with purpose. Join our Cause to create a person-focused and economically sustainable health care system.    Who We Are Looking For:   Every day, Cambia’s dedicated team of Pharmacy leaders are living our mission to make health care easier and lives better. As a member of the Pharmacy Service leadership team, our Manager Clinical Pharmacy Quality and Affordability Programs l eads a team of clinical pharmacy professionals responsible for the strategy, development, implementation, and optimization of pharmacy quality, affordability, and medication management programs across all lines of business. Oversees a portfolio of clinical programs and vendor partnerships focused on improving quality outcomes, medication use, affordability, member experience, and Medicare Stars performance while supporting Cambia's overall health care and business objectives. The scope includes medications covered under the pharmacy benefit, medical benefit and specialty medications – all in service of creating a person-focused health care experience. As a people leader, you are willing to learn and grow, understanding that leadership is a craft that is continuously honed as you support your team and the lives that depend upon us. Are you energized by building and mentoring high-performing teams of clinical pharmacists who are passionate about quality and patient safety? Do you want your leadership to matter beyond the bottom line—where clinical excellence, health equity, and making health care easier are the measures of success? Then this role may be the perfect fit.   What You Bring to Cambia:   Qualifications:    Bachelor's degree in Pharmacy or Pharm.D; Residency certificate or advanced degree in health care administration, economics, public health, pharmacy administration, finance, or equivalent field preferred Minimum 3 years of experience in patient care setting as well as management or professional business experience in a managed health care system, medical group, hospital, or related business in health care delivery industry or an equivalent combination of education and experience Licensed pharmacist in state of practice Skills and Attributes:   Strong clinical pharmacy background with ability to demonstrate clinical therapy skills and knowledge. Strong business acumen, knowledge of health care economics and financing, health care and PBM industry dynamics, benefit design, provider contracting strategies, techniques, and operational processes. Demonstrated ability to develop and execute strategic initiatives, identify opportunities for innovation, and translate complex business challenges into actionable solutions. Experience managing external vendors, consultants, or strategic partners, including performance monitoring, operational governance, implementation oversight, and issue resolution. Demonstrated success influencing stakeholders and leading cross-functional initiatives in a matrixed environment. Ability to build partnerships, align priorities, and drive results across multiple business areas without direct authority. Excellent verbal and written communication skills; strong business analytical skills and abilities; project management and coordination ability; ability to function effectively as a management team member. Demonstrated ability to review and analyze data from medication claims, recommending programs and policies to encourage appropriate utilization. Ability to select, train and lead staff, manage resources and prioritize workload. Demonstrated knowledge of: Medicare/CMS regulations and applicability in administering the Medicare Product; Pharmaceutical products, including orals, injectables, infusion products, and chemotherapy; Health care coding and payment systems (such as ICD-10, CPT, HCPCS, NDC); Compliance related activities, legislative and regulatory activities; state and federal laws and rules regarding the practice of pharmacy and regulation of health care industry practices, such as DOLI, PPACA and HIPAA. Experience with AI tools and technologies to enhance productivity and decision-making in professional settings highly desired What You Will Do at Cambia:    Develops, prioritizes, implements, and optimizes pharmacy quality, affordability, and medication management programs, including Medicare Stars, HEDIS, and other clinical initiatives. Identifies opportunities to improve program performance, member outcomes, and operational effectiveness. Builds partnerships and leads cross-functional initiatives involving Pharmacy, Quality, Analytics, Product, Provider Enablement, Care Management, Operations, Network Management, and external vendors to achieve organizational goals. Assures service levels and activities meet client service level agreements, as well as contractual obligations and compliance, such as state, federal, and CMS regulations or specific member contracts, with service guarantees. Provides routine and/or intermittent reporting and analysis as appropriate of clinical program activities that fall under their oversight. Ensure continuous quality assurance inclusive of documented policies, procedures, and workflows for all programs. Provides leadership and mentorship to direct reports, including clinical and non-clinical staff, through development and tracking of performance goals and objectives, as well as through quarterly performance conversations. Prioritizes and manages work activities of clinical pharmacist consultant staff. Collaborates with the Pharmacy Directors, VPs, and oth