Senior Medicaid Pharmacy Consultant

This role is best suited for pharmacists with experience in state Medicaid agencies, Medicaid managed care organizations, PBMs, government healthcare consulting, or Medicaid pharmacy policy and operations.

*Candidates whose backgrounds are primarily retail, hospital, or dispensing-focused pharmacy are unlikely to be the right fit*

Key Responsibilities

• Advise state Medicaid and public-sector healthcare clients on pharmacy policy, reimbursement, and operational strategy.
• Lead and support projects involving Medicaid pharmacy program design, managed care initiatives, reimbursement analysis, and regulatory compliance.
• Analyze pharmacy and healthcare data to identify trends, assess program performance, and develop actionable recommendations.
• Evaluate the impact of federal and state regulatory changes on Medicaid pharmacy programs.
• Manage project timelines, deliverables, budgets, and client communications.
• Collaborate with Medicaid leadership, managed care plans, PBMs, providers, and other stakeholders to address complex pharmacy-related challenges.
• Contribute to business development efforts, proposal creation, and strategic growth initiatives.
• Mentor junior team members and support the development of best practices, tools, and thought leadership across the organization.

Qualifications

• Active, unrestricted Pharmacist (RPh) license.
• 5+ years of experience in Medicaid pharmacy, government healthcare, managed care, PBMs, healthcare consulting, or related policy-focused environments.
• Direct experience supporting Medicaid programs, including areas such as reimbursement, pharmacy operations, policy implementation, state plan amendments, waivers, or regulatory compliance.
• Strong analytical and problem-solving skills, including experience working with large healthcare datasets and Excel-based analysis.
• Excellent communication and stakeholder management abilities.
• Proven track record managing multiple priorities and contributing to complex, client-facing projects.

Preferred Experience

• PharmD degree.
• Experience advising or consulting with state Medicaid agencies.
• Prior work within a Medicaid managed care organization, PBM, or state Medicaid program.
• Knowledge of 340B, value-based purchasing arrangements, alternative payment models, Medicaid managed care reimbursement, or pharmacy procurement initiatives.
• Experience partnering with actuaries, healthcare economists, or reimbursement teams.
• Master's degree in Public Health, Health Policy, Public Administration, Business Administration, or a related field.

This is an opportunity to help shape pharmacy policy, reimbursement strategy, and program performance for state healthcare programs while working on some of the most impactful Medicaid initiatives in the market.