Utilization Review Pharmacist Jobs in Renton, WA

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.

Candidates must reside within commutable distance of that location or be 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 leads 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 other leadership in coordinating corporate-wide activities related to the appropriate use of medications, improved quality related to medication therapy, promotion of cost-effective prescribing, and reduction in short-term and long-term overall costs to internal and external clients.

• Provides strategic oversight of assigned vendor relationships, including implementation, performance monitoring, governance, operational optimization, and evaluation of new opportunities that support organizational priorities.

• Identifies emerging trends, regulatory changes, and innovation opportunities that improve quality outcomes, affordability, member experience, and business performance.

• Handles all management level responsibilities for staff, hiring, firing, coaching, counseling, and retention. Manages financial targets and department budget, authorizes expenditures, monitors workforce allocation and resources, and oversees project plans.

• As a member of our strong leadership community, you will provide direction to your team, engage them towards common goals and create a positive experience that helps people flourish.

FTEs Supervised

• Up to 10 direct reports

#LI-Hybrid

Pay ranges vary based on the candidate's work location. The expected hiring range depends on skills, experience, education, and training; relevant licensure / certifications; and performance history.

• Oregon, Washington, Utah, and Idaho:The expected hiring range is$148,800 - $201,300, the full salary range is$140,000 - $228,000 and the bonus target is25%.

• North Dakota:The expected hiring range is$146,149.85 - $197,732.15 andthe full salary range is $129,767 - $214,115.

About Cambia

Working at Cambia means being part of a purpose-driven, award-winning culture built on trust and innovation anchored in our 100+ year history. Our caring and supportive colleagues are some of the best and brightest in the industry, innovating together toward sustainable, person-focused health care. Whether we're helping members, lending a hand to a colleague or volunteering in our communities, our compassion, empathy and team spirit always shine through.

Why Join the Cambia Team?

At Cambia, you can:

• Work alongside diverse teams building cutting-edge solutions to transform health care.
• Earn a competitive salary and enjoy generous benefits while doing work that changes lives.
• Grow your career with a company committed to helping you succeed.
• Give back to your community by participating in Cambia-supported outreach programs.
• Connect with colleagues who share similar interests and backgrounds through our employee resource groups.

We believe a career at Cambia is more than just a paycheck - and your compensation should be too. Our compensation package includes competitive base pay as well as a market-leading 401(k) with a significant company match, bonus opportunities and more.

In exchange for helping members live healthy lives, we offer benefits that empower you to do the same. Just a few highlights include:

• Medical, dental and vision coverage for employees and their eligible family members, including mental health benefits.
• Annual employer contribution to a health savings account.
• Generous paid time off varying by role and tenure in addition to 10 company-paid holidays.
• Market-leading retirement plan including a company match on employee 401(k) contributions, with a potential discretionary contribution based on company performance (no vesting period).
• Up to 12 weeks of paid parental time off (eligibility requires 12 months of continuous service with Cambia immediately preceding leave).
• Award-winning wellness programs that reward you for participation.
• Employee Assistance Fund for those in need.
• Commute and parking benefits.

Learn more about our benefits.

We are happy to offer work from home options for most of our roles. To take advantage of this flexible option, we require employees to have a wired internet connection that is not satellite or cellular and internet service with a minimum upload speed of 5Mb and a minimum download speed of 10 Mb.

As part of our security requirements, new hires will need access to a personal mobile device to set up Multi-Factor Authentication (MFA) upon joining the company. MFA is an important layer of protection for accessing Cambia systems and is required for all employees.