Senior Consultant: Medicare Part D Pharmacy (Full-time)
Job Summary
The Senior Consultant, Medicare Part D Pharmacy provides expert consulting support focused on Medicare Part D plan operations, formulary administration, and regulatory compliance. This role partners with clients and internal stakeholders to design, administer, and optimize Part D pharmacy programs, ensuring operational excellence, CMS alignment, and sustainable plan performance.
Key Responsibilities
- Serve as a subject matter expert in Medicare Part D plan and pharmacy operations, with emphasis on formulary development, administration, and benefit design.
- Provide strategic and operational guidance on formulary management, including CMS requirements, submission processes, and ongoing maintenance.
- Support Pharmacy & Therapeutics (P&T) Committee activities, including governance, documentation, regulatory compliance, and operational execution.
- Advise on plan-level operational processes impacting formulary administration, utilization management, and beneficiary access.
- Support CMS Program Audits with a primary focus on Formulary Administration and Coverage Determinations, Appeals, and Grievances (CDAG).
- Develop, update, and maintain policies, procedures, and work plans related to Part D plan and formulary operations.
- Oversee and administer ongoing monitoring programs to ensure continued compliance with CMS guidance.
- Monitor and guide implementation of corrective action plans, ensuring sustainable operational and regulatory outcomes.
- Mentor team members and guide work products using structured project management methodologies.
- Manage client communications, expectations, and deliverables while providing high-quality consultative service.
- Support client interim staffing needs as required.
- Travel as required to support client engagements.
Additional Knowledge Areas
- Working knowledge of Part D claims adjudication and Prescription Drug Event (PDE) processing to support plan operations, issue identification, and regulatory compliance.
Qualifications
- Bachelor’s degree or Doctor of Pharmacy (PharmD) required; active Pharmacist license required.
- Minimum of 10 years of experience in healthcare, government programs, PBM operations, compliance, quality, or related fields.
- Extensive experience with Medicare Part D plan operations, formulary development and administration, and P&T Committee processes.
- Strong knowledge of Medicare and/or Medicaid regulatory standards.
- Advanced proficiency in Microsoft Word, Excel, Access, and PowerPoint.
- Ability to communicate complex regulatory and operational concepts clearly to internal and external stakeholders.
- Strong organizational, analytical, and problem-solving skills with the ability to work independently and manage multiple priorities under tight timelines.
Preferred Qualifications
- Experience with PACE plans and/or 340B programs.
- Experience with Medicaid and Exchange pharmacy operations and regulations.
- Experience supporting Medicare Star Ratings pharmacy measures, including medication adherence and quality improvement initiatives.
- Familiarity with Medication Therapy Management (MTM) program design, operations, or performance monitoring within Medicare Part D.
- Advanced degree or professional certification in pharmacy, compliance, audit, or a related discipline.
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Senior Consultant, Medicare Part D Pharmacy (Full-time)
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