Pbm Implementation Jobs in California (NOW HIRING)

Founded in 1977 as the Senior Care Action Network, SCAN began with a simple but radical idea: that older adults deserve to stay healthy and independent. That belief was championed by a group of community activists we still honor today as the "12 Angry Seniors." Their mission continues to guide everything we do.

Today, SCAN is a nonprofit health organization serving more than 500,000 people across Arizona, California, Nevada, New Mexico, Texas, and Washington, with over $8 billion in annual revenue. With nearly five decades of experience, we have built a distinctive, values-driven platform dedicated to improving care for older adults.

Our work spans Medicare Advantage, fully integrated care models, primary care, care for the most medically and socially complex populations, and next-generation care delivery models. Across all of this, we are united by a shared commitment: combining compassion with discipline, innovation with stewardship, and growth with integrity.

At SCAN, we believe scale should strengthen-not dilute-our mission. We are building the future of care for older adults, grounded in purpose, accountability, and respect for the people and communities we serve.

The Job

The Manager of Pharmacy Operations is responsible for providing leadership and direction to the pharmacy operations team while working cross-functionally with other departments and the Pharmacy Benefit Manager (PBM) on CMS, DHCS, and other states regulatory requirements. The role ensures regulatory compliance related to prescription drug event (PDE) data, Drug Plan Finder processes, financial information reporting, Part D reporting, pharmacy benefit configuration and testing, and plan benefit package reviews during BID submission. It provides support during CMS Part D and other regulatory audits (e.g., 1/3 financial audit, National MEDIC audits) and ensures Part D deadlines and timeframes are met. This position supports pharmacy leadership to drive departmental and organizational goals. This position oversees pharmacy benefit administrators and pharmacy analysts, providing leadership, direction, and fostering continuous team development.

You Will

• Ensure regulatory compliance with respect to prescription benefits set up and year-round CMS Program Audit, 1/3 Financial audit, National MEDIC, and other audits readiness; Provide leadership and support during all CMS Regulatory Audits related to pharmacy operations; e.g., ensure accuracy of written responses and/or documentation for the pharmacy audits; Ensure audit documentation is prepared according to audit instructions and provided within the specified audit timeframe; Prepare written responses or documentation for pharmacy audits.

• Serve as a subject matter expert for Part D Reporting requirements, Pharmacy Access Requirements, Prescription Drug Event data, Financial Information Reporting and Drug Plan Finder files by keeping up to date with Medicare requirements; Maintain current knowledge of Medicare Part D regulations by participating in CMS calls and reading released guidance and implementing changes to maintain compliance.

• Oversee the accurate implementation and maintenance of pharmacy benefits, pharmacy account structure, pharmacy network, including GEO access requirements; Lead the team to review and ensure the accuracy of the Pharmacy Benefits for the annual BID submission to CMS; Ensure Annual Enrollment Period (AEP) and 1/1 operational readiness and assist in training of other departments on Pharmacy products.

• Lead automation efforts related to the Prescription Drug Event, Benefits Configuration and Testing Initiatives; Analyze and monitor large data sets that are exchanged from SCAN to the PBM using a variety of reporting tools.

• Accountable for ensuring eligibility and coordination of benefit files are sent to the PBM for processing and assess if file enhancements are needed; Ensure the PBM is processing Prescription Drug Events, Automated Claims Reprocessing and Financial Information Data according to CMS regulatory standards by conducting daily oversight; Ensure PBM oversight of claims adjudication; Oversee PBM operations to ensure high service level to SCAN and our members; Maintain strong rapport with PBM representatives such that team's goals and needs are met.

• Prepare documentation for Service Area Expansion application submission to CMS.

• Support Part C and Part D Data Validation audits, including Medicare Prescription Payment Plan Module.

• Participate in Medicare Plan Finder testing and other CMS-related activities.

• Collaborate with other SCAN departments: Compliance, Marketing, Digital, HCI, Product, Finance and Member Services by participating in cross-functional meetings and supporting achievement of team's goals; Foster strong relationships with internal departments and external providers. Identify operational gaps and work with the staff or PBM by providing feedback/recommendations on how to fix operational gaps and ensures follow through; Resolve issues and monitor results of daily staff activities, keeping management informed of key issues and problems as encountered.

• Develop, implement, and maintain department's policies and procedures, desktop procedures and standard operating procedures to ensure ongoing compliance; Instill a culture of continuous process improvement, efficiency, collaboration, operational excellence and compliance amongst team.

• Provide Pharmacy Analyst and Pharmacy Benefits Administrator team support by communicating job expectations, giving continual feedback, enforcing policies and procedures, and conducting training programs; Accomplish staff results by communicating job expectations; planning, monitoring, and appraising job results; coaching and counseling employees; initiating, coordinating, and enforcing systems, policies, and procedures; Maintain staff by recruiting, selecting, orienting, and training employees; maintaining a safe and secure work environment; developing personal growth opportunities.

• Conduct training sessions of the pharmacy benefit and Part D programs to other departments as needed; Train staff on job-related functions and refresher courses as updates to processes or requirements occur.

• We seek Rebels who are curious about AI and its power to transform how we operate and serve our members.

• Actively support the achievement of SCAN's Vision and Goals.

• Other duties as assigned.

Your Qualifications

• Five (5) years or more of Medicare Part D experience with a health plan or PBM required.

• Three (3) years of leadership experience in a managed care setting with full scope of supervision for non-licensed staff.

• Three (3) years or more of experience in data analysis required.

• Bachelor's Degree or equivalent experience - Business/Healthcare.

• Active Pharmacy Technician License preferred.

• Expert in Medicare Part D. Knowledge of CMS Part D regulations e.g., CMS Call Letters, MAPD application, Claims Processing, Part D Reports.

• Ability to create, develop and implement process improvement and the ability to instill that focus in a team.

• Ability to work cross-functionally and collaboratively across the organization.

• Technologically savvy and able to utilize information systems effectively (MS Office - Word, Excel, PowerPoint, Access, Visio, Outlook; SQL)

• Ability to manage and adapt to a significant change.

• Strong interpersonal skills, including excellent written and verbal communication skills.

• Strong organizational skills; ability to multitask and meet multiple competing deadlines.

• Ability to appropriately maintain confidentiality.

• Strong analytical and critical thinking skills.

• Ability to research, analyze, and problem solve.

• Self-starter that can take the lead on a project and manage its progress for completion.

What's in it for you?

• Base salary range: $80,300 to $116,197 per year.

• Internal title: Manager, Pharmacy Operations

• Work Mode: Fully Remote

• An annual employee bonus program

• Robust Wellness Program

• Generous paid-time-off (PTO)

• 11 paid holidays per year, plus 1 floating holiday, plus 1 birthday holiday

• Excellent 401(k) Retirement Saving Plan with employer match and contribution

• Robust employee recognition program

• Tuition reimbursement

• An opportunity to become part of a team that makes a difference to our members and our community every day!

We're always looking for talented people to join our team! Qualified applicants are encouraged to apply now!

At SCAN we believe that it is our business to improve the state of our world. Each of us has a responsibility to drive Equality in our communities and workplaces. We are committed to creating a workforce that reflects our community through inclusive programs and initiatives such as equal pay, employee resource groups, inclusive benefits, and more.

SCAN is proud to be an Equal Employment Opportunity and Affirmative Action workplace. Individuals seeking employment will receive consideration for employment without regard to race, color, national origin, religion, age, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender perception or identity, age, marital status, disability, protected veteran status or any other status protected by law. A background check is required.

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Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities

The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor's legal duty to furnish information. 41 CFR 60-1.35(c)