Mgr, Formulary & Pharmacy Benefits

SummaCare

• 1200 E Market St, Akron, OH Full-Time / 40 Hours / Days
• Hybrid after training Based in Akron, Ohio, SummaCare provides Medicare Advantage, individual and family and commercial insurance plans.

SummaCare has one of the highest rated Medicare Advantage plans in the state of Ohio, with a 4.5 out of 5-Star rating for 2026 by the Centers for Medicare and Medicaid Services (CMS). Known for its excellent customer service and personalized attention to members, SummaCare is committed to building lasting relationships. Employees can expect competitive pay and benefits.

Summary :

This position is primarily responsible for formulary management, pharmacy and medical drug benefits and drug utilization management support. Provides day-to-day pharmacy and clinical support to Pharmacy Management and other SummaCare Departments. Manages and oversees Pharmacy Benefit Specialist and Pharmacist Program Coordinator

• Medical Benefit and Specialty Pharmacy to ensure members needs and compliance requirements are addressed.

Management of the Medication Therapy Management (MTM) program and other Pharmacy meetings as delegated. These interventions are aimed at improving pharmaceutical care for our members, ensuring compliance and managing total cost of drug therapy. 1.

Formal Education Required :

a. Pharm. D. or Bachelor degree in pharmacy from an accredited College or School of Pharmacy. b. Must be a licensed pharmacist within the United States. 2.

Experience and Training Required :

a. Three (3) years experience in pharmacy administration in a health plan or Pharmacy Benefit Manager (PBM) to include: i. Two (2) years working knowledge of Medicare.

Additional Job Duties :

1. Manage SummaCare custom formularies through weekly updates and annual reviews with PBM (Pharmacy Benefit Manager), in compliance with CMS and Ohio Department of insurance (ODI). Reviews and prepares all materials for SummaCare Pharmacy & Therapeutics Committee Meetings. 2. Manage the Medicare Medication Therapy Management (MTM) program and the third party vendor responsible for administration of the MTM program. 3. Collaborates with non-clinical staff in performing auditing and monitoring of PBM activities, including self-audits in areas like Affordable Care Act (ACA) and Medicare Part D. 4. Provides oversite for Site of Care (SOC) and Utilization Management (UM) reviews for Medical organizational determinations. 5. Provides clinical oversight for daily PBM monitoring including, Daily Denied Claims and Coverage Determination Monitoring. 6. Facilitates problem identification and resolution with PBM and Pharmacy Department including corrective actions and monitoring of resolutions 7. Administers, monitors, coordinates, implements, and reports on utilization information related to drug benefits for all lines of business. 3.

Other Skills, Competencies and Qualifications:

a. Effective leadership and management of staff b. Read, Analyze and interpret primary medical literature, government regulations, CMS memos, general business periodicals, professional journals, technical procedures, standards and specifications. c. Apply principles of logical thinking to define problems, collect data, establish facts, draw valid conclusions and prepare recommendations d. Efficient in Microsoft Word, Excel, Outlook, and PowerPoint. e. Effective interface with all staff levels f. Organize and manage time to accurately complete tasks within designated time frames in a fast-paced environment. g. Maintain current knowledge of and comply with regulatory and company policies and procedures. h. Maintain confidentiality of member health and business information. i. Ability to adjust work hours to meet business demands. j.

Population Specific Competency:

Ability to effectively interact with patients/customers with the understanding of their needs for self-respect and dignity 4.

Level of Physical Demands:

a.

Light:

Exerts up to 20 pounds of force occasionally and/or up to ten pounds of force frequently, and/or a negligible amount of force continuously. Equal Opportunity Employer/Veterans/Disabled $66.27/hr

• $99.

40/hr The salary range on this job posting/advertising is base salary exclusive of any bonuses or differentials. Many factors, such as years of relevant experience and geographical location are considered when determining the starting rate of pay. We believe in the importance of pay equity and consider internal equity of our current team members when determining offers. Please keep in mind that the range that is listed is the full base salary range. Hiring at the maximum of the range would not be typical. Summa Health offers a competitive and comprehensive benefits program to include medical, dental, vision, life, paid time off as well as many other benefits. Basic Life and Accidental Death & Dismemberment (AD&D) Supplemental Life and AD&D Dependent Life Insurance Short-Term and Long-Term Disability Accident Insurance, Hospital Indemnity, and Critical Illness Retirement Savings Plan Flexible Spending Accounts

• Healthcare and Dependent Care Employee Assistance Program (EAP) Identity Theft Protection Pet Insurance Education Assistance Daily Pay Mgr, Formulary & Pharmacy Benefits 3.5 3.5 out of 5 stars 1200 East Market Street, Akron, OH 44305 $66.27
• $99.40 an hour
• Full-time Summa Health 575 reviews $66.27
• $99.40 an hour
• Full-time SummaCare
• 1200 E Market St, Akron, OH Full-Time / 40 Hours / Days
• Hybrid after training Based in Akron, Ohio, SummaCare provides Medicare Advantage, individual and family and commercial insurance plans.

SummaCare has one of the highest rated Medicare Advantage plans in the state of Ohio, with a 4.5 out of 5-Star rating for 2026 by the Centers for Medicare and Medicaid Services (CMS). Known for its excellent customer service and personalized attention to members, SummaCare is committed to building lasting relationships. Employees can expect competitive pay and benefits.

Summary :

This position is primarily responsible for formulary management, pharmacy and medical drug benefits and drug utilization management support. Provides day-to-day pharmacy and clinical support to Pharmacy Management and other SummaCare Departments. Manages and oversees Pharmacy Benefit Specialist and Pharmacist Program Coordinator

• Medical Benefit and Specialty Pharmacy to ensure members needs and compliance requirements are addressed.

Management of the Medication Therapy Management (MTM) program and other Pharmacy meetings as delegated. These interventions are aimed at improving pharmaceutical care for our members, ensuring compliance and managing total cost of drug therapy. 1.

Formal Education Required :

a. Pharm. D. or Bachelor degree in pharmacy from an accredited College or School of Pharmacy. b. Must be a licensed pharmacist within the United States. 2.

Experience and Training Required :

a. Three (3) years experience in pharmacy administration in a health plan or Pharmacy Benefit Manager (PBM) to include: i. Two (2) years working knowledge of Medicare.

Additional Job Duties :

1. Manage SummaCare custom formularies through weekly updates and annual reviews with PBM (Pharmacy Benefit Manager), in compliance with CMS and Ohio Department of insurance (ODI). Reviews and prepares all materials for SummaCare Pharmacy & Therapeutics Committee Meetings. 2. Manage the Medicare Medication Therapy Management (MTM) program and the third party vendor responsible for administration of the MTM program. 3. Collaborates with non-clinical staff in performing auditing and monitoring of PBM activities, including self-audits in areas like Affordable Care Act (ACA) and Medicare Part D. 4. Provides oversite for Site of Care (SOC) and Utilization Management (UM) reviews for Medical organizational determinations. 5. Provides clinical oversight for daily PBM monitoring including, Daily Denied Claims and Coverage Determination Monitoring. 6. Facilitates problem identification and resolution with PBM and Pharmacy Department including corrective actions and monitoring of resolutions 7. Administers, monitors, coordinates, implements, and reports on utilization information related to drug benefits for all lines of business. 3.

Other Skills, Competencies and Qualifications:

a. Effective leadership and management of staff b. Read, Analyze and interpret primary medical literature, government regulations, CMS memos, general business periodicals, professional journals, technical procedures, standards and specifications. c. Apply principles of logical thinking to define problems, collect data, establish facts, draw valid conclusions and prepare recommendations d. Efficient in Microsoft Word, Excel, Outlook, and PowerPoint. e. Effective interface with all staff levels f. Organize and manage time to accurately complete tasks within designated time frames in a fast-paced environment. g. Maintain current knowledge of and comply with regulatory and company policies and procedures. h. Maintain confidentiality of member health and business information. i. Ability to adjust work hours to meet business demands. j.

Population Specific Competency:

Ability to effectively interact with patients/customers with the understanding of their needs for self-respect and dignity 4.

Level of Physical Demands:

a.

Light:

Exerts up to 20 pounds of force occasionally and/or up to ten pounds of force frequently, and/or a negligible amount of force continuously. Equal Opportunity Employer/Veterans/Disabled $66.27/hr

• $99.

40/hr The salary range on this job posting/advertising is base salary exclusive of any bonuses or differentials. Many factors, such as years of relevant experience and geographical location are considered when determining the starting rate of pay. We believe in the importance of pay equity and consider internal equity of our current team members when determining offers. Please keep in mind that the range that is listed is the full base salary range. Hiring at the maximum of the range would not be typical. Summa Health offers a competitive and comprehensive benefits program to include medical, dental, vision, life, paid time off as well as many other benefits. Basic Life and Accidental Death & Dismemberment (AD&D) Supplemental Life and AD&D Dependent Life Insurance Short-Term and Long-Term Disability Accident Insurance, Hospital Indemnity, and Critical Illness Retirement Savings Plan Flexible Spending Accounts

• Healthcare and Dependent Care Employee Assistance Program (EAP) Identity Theft Protection Pet Insurance Education Assistance Daily Pay