• Coordinate the implementation and execution of medical drug strategy and management of the pre-determination process for specialty pharmacy. • Drive biosimilar adoption, utilization pathways, clear/white bagging policies, specialty pharmacy partnerships, and sourcing strategies. • Optimize infusion and specialty drug administration settings for cost savings and improved outcomes. • Lead execution of CMS/state drug requirements across systems and providers, Part B Implementation. • Lead QAI efforts for medical drug spend and utilization support cost containment and driving medical forecasting for consistent execution. • Coordinate and collaborate with Pharmacy, Medical, Network, Finance, and Operations to ensure unified execution. • Assist in the development of integrated service delivery to members and oversee data and processes to maintain industry standards and practices. • Assist the Director in developing processes to manage appropriate utilization and assure appropriate payment for specialty/medical drug services and programs. • Interact with providers and staff to manage benefits aligned with regulations, URAC and NCQA regulations and CareSource policies and vision. • Oversee CQI (Continuous Quality Improvement) activities and document departmental processes for internal and external use. • Review and revise workflows to maximize efficiencies. • Monitor productivity and utilization trends. • Regularly report all specialty pharmacy/medical drug data and program performance. • Ensure compliance with and reporting of all regulatory requirements. • Analyze and formulate recommendations based on data. • Maintain and update all departmental policies and procedures. • Act as liaison with other departments to assist with research and intervention. • Perform any other job related duties as requested.