Supervisor, Pharmacy Benefits and Formulary

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 JobThis position provides leadership and oversight of formulary management, pharmacy benefits, and Part D program implementation for a senior-focused Medicare Advantage organization. The Supervisor leads the Formulary and Benefits team and oversees formulary management, benefit administration, PBM operations and performance, utilization management, transition program, P&T Committee activities, pharmacy networks, and related member and other marketing materials across all business lines.The role ensures CMS regulatory compliance, operational excellence, and enhanced member experience while supporting the organization's mission, Part D cost management, growth, and profitability. The Supervisor also monitors industry trends, regulatory changes, and best practices to drive continuous improvement and effective pharmacy benefit management.You WillLead and support CMS Part D program audits, One-Third Financial audits, Data Validation Audits and other CMS’s regulatory audits; manage audit universe files; including HPMS reporting requirements and ensure ongoing audit readiness through mock audits, compliance monitoring, and post-submission reviews.Lead the Pharmacy Benefits and Formulary team for compliance and effectiveness (e.g., ensure regulatory compliance with P&T operations, formulary management and submissions to CMS, Pharmacy benefits administration, Transition Program, annual Part D bid submission process, pharmacy related marketing materials, website content, and pharmacy networks). Provide support with Service Area Expansion application review and submission and market analysis.Oversee cap deduct activities and issue resolution; partner with the contracted PBM and internal stakeholders on quality improvement, process enhancement, operational escalations, and cross functional coordination with Network Management, Provider Relations, Compliance, Legal, Analytics, and contracted partners.Implement new CMS programs and process enhancements that strengthen compliance, efficiency, and member experience through routine tracking and trending. Support CMMI initiatives.Ensure AEP (annual election period) and 1/1 readiness across applicable operational areas. Perform routine monitoring to ensure Part D compliance and detect performance issues or operational gaps. Maintain up-to-date clinical policies and desktop procedures, ensuring internal adherence across formulary operations.Serve as subject matter expert for Part D Formulary, Inflation Reduction Act, Maximum Fair Price Drugs, Medicare Prescription Payment plan program. Monitor pipeline and the payer industry changes to identify Part D trends.Oversee development and implementation of Part D Utilization Management criteria and other quality controls.Oversee PBM operations, collaborating on process improvements and CMS updates to support quality performance and enhance member experience.Identify and implement responsible uses of AI, automation, and other tools to reduce manual reporting, improve workflow efficiency, strengthen quality controls, and enable pharmacists to focus on higher-value clinical, member, and oversight activities. Provide supervision, development, and coaching to pharmacists, technicians, and support staff, fostering a culture of process improvement, operational excellence, and compliance. Serve as an operational backup when necessary to ensure required work is completed accurately and on time, including during volume surges, vacancies, audits, and other business continuity events.Supervises/Manages Others (i.e. hires, performance reviews, corrective action, etc.)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 QualificationsGraduate or Advanced Degree, Pharm D required.Active Pharmacist License required.Completion of a PGY1 and/or PGY2 residency or equivalent clinical practice experience preferred.Demonstrated knowledge of and experience monitoring Medicare Part D regulations, required.5+ years or more of managed care pharmacy experience; or equivalent experience in a managed care setting, strongly preferred.1-2 years leadership/management experience strongly preferred.Knowledge and experience with organizing quality improvement initiatives and presenting findings to leadership.Leadership - Lead and inspire teams to achieve performance goals, offering guidance and supportProblem Solving - Good problem-solving skillsCommunication - Good communication and interpersonal skillsStrong analytical, problem-solving, and decision-making abilities - Ability to think strategically while executing tactically - Detail-oriented and highly adaptable to a fast-paced, evolving environment - Demonstrated ability to manage multiple priorities simultaneouslyProven leadership and accountability skills - Strong organizational, time management, and project management capabilities - Self-starter with a resourceful and innovative mindset - Effective across cross-functional teams and collaborative environments Exceptional verbal, written, and interpersonal communication skills - High commitment to professionalism and customer service - Computer proficiency required to perform essential job functions Communication & Professionalism - Exceptional verbal, written, and interpersonal communication skills - High commitment to professionalism and customer service - Computer proficiency required to perform essential job functions What's in it for you?Base salary range: $125,400 to $181,419 per year.Work Mode: RemoteAn annual employee bonus programRobust Wellness ProgramGenerous paid-time-off (PTO)11 paid holidays per year, plus 1 floating holiday, plus 1 birthday holidayExcellent 401(k) Retirement Saving Plan with employer match and contributionRobust employee recognition programTuition reimbursementAn 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.#LI-CS2#LI-RemoteEqual Opportunity Employer/Protected Veterans/Individuals with DisabilitiesThe 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)SummaryLocation: Long Beach, CAType: Full time