Job Description

The Pharmacy Program Manager - Medicare performs Medicare operational and clinical pharmacy processes for the Steward Health Choice Generations beneficiaries. The Pharmacy Program Manager oversees the maintenance of the Medicare formulary, configures benefit changes with the PBM, and creates audit protocols for both internal and PBM related activities. The Pharmacy Program Manager also performs coverage determinations and appeals. The Pharmacy Program Manager participates in efforts to improve clinical program quality and pharmacy performance measures (e.g. Medicare Stars, Patient Safety, OMS, MTMP, etc.). Assures Medicare Part D pharmacy benefit and formulary administration (FA) effectiveness. Assures Medicare Part D initial coverage determination and redetermination (CDAG) operations effectiveness and compliance with CMS regulations. Conduct Medicare Part D coverage determinations effectively and efficiently. Conduct initial coverage determinations and redeterminations in compliance with Medicare Part D regulations. Assure Medicare Part D clinical programs are implemented to promote clinically appropriate and safe medication use.


Pharmacy degree from an accredited college of pharmacy required; PharmD strongly preferred

At least two (2) years of practice experience in Medicare Part D operations for a health plan or Pharmacy Benefit Manager (PBM)

At least two (2) years of practice experience in developing policies and procedures, desktops, and Medicare Part D audit related deliverables

Proficient in the principles and practices of managed care pharmacy

Proficient in Medicare Part D pharmacy benefit and formulary operations

Knowledge of Medicare Part D regulations and guidelines

Knowledge of application of CMS compendia in the clinical decision-making process of coverage determination review

Pharmacist license in any U.S. state; in good standing

Application Instructions

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