Job Details

Job Description:
The Director of Pharmacy leads the strategic vision and operational execution of pharmacy benefits, ensuring alignment with clinical excellence, financial sustainability, regulatory compliance, and member-centered outcomes. This role oversees end-to-end pharmacy benefit design, formulary management, PBM partnerships, utilization management, quality improvement initiatives and pharmacy operations across multiple lines of business including Medicare, Medicaid, Exchange, CHP+ and commercial plans. The position partners cross-functionally with executive leadership, finance, legal, quality, care management and operational teams to optimize medication access, adherence, cost savings and overall pharmacy performance. This individual will also lead pharmacy program innovation, monitor industry trends and guide strategic initiatives related to formulary governance, specialty pharmacy, value-based programs and regulatory compliance.

Responsibilities:

• Provide strategic oversight of pharmacy benefit operations including formulary strategy, benefit design, utilization management and cost containment initiatives.

• Oversee Pharmacy Benefit Manager (PBM) performance, contract compliance and operational effectiveness.

• Lead formulary management initiatives, including specialty pharmacy, biosimilars, opioid safety, behavioral health integration and 340B strategy.

• Develop and implement utilization management protocols, prior authorization oversight and medication adherence programs.

• Provide leadership and oversight of pharmacy and therapeutics committee activities and formulary governance.

• Manage pharmacy staff responsible for prior authorization, medication therapy management (MTM), care coordination and utilization review.

• Develop team performance standards, conduct evaluations, support training and staff development, and foster employee engagement.

• Negotiate and manage PBM contracts, service level agreements, rebate programs and vendor performance metrics.

• Partner with legal, finance, and operational teams on contract negotiations, RFP processes and vendor oversight.

• Monitor pharmacy financial performance, rebate administration and budget management.

• Collaborate with quality, care management and member services teams to integrate pharmacy initiatives into broader population health strategies.

• Develop and implement strategies to improve pharmacy program quality, cost effectiveness, and member outcomes.

• Monitor pharmacy industry trends, healthcare reform initiatives and emerging therapies to identify improvement opportunities.

• Support performance initiatives related to HEDIS, CAHPS, CMS Star Ratings, NCQA accreditation and other regulatory quality metrics.

• Analyze pharmacy utilization and cost data to identify savings opportunities and operational efficiencies.

• Ensure compliance with Medicare, Medicaid, DOI, NCQA and other regulatory requirements.

• Maintain pharmacy policies, procedures and documentation standards.

• Prepare and present operational, financial, and strategic reports to executive leadership and governance committees.

• Lead cross-functional projects involving operational, financial, quality, regulatory and technology initiatives.

• Participate in organizational committees related to compliance, medical management, quality improvement and pharmacy governance.

• Communicate strategic goals, operational performance and key challenges to executive stakeholders.

Requirements:

• Doctor of Pharmacy

• 5+ years of pharmacy department management experience within a managed care organization, PBM, Medicare or Medicaid environment

• Prior leadership experience at the director level or higher (preferred)

• Experience with pharmacy operations, formulary management, rebate management, contract negotiations, utilization management and program development required

• Active pharmacist license required

• Strong knowledge of managed care pharmacy, pharmacy benefit design, formulary management, PBM operations and utilization management

• Experience with Medicare, Medicaid, commercial and exchange pharmacy programs, and regulatory requirements

• Knowledge of HEDIS, NCQA, CMS star ratings, NCPDP standards, MTM, prior authorization and drug utilization review

• Strong analytical, pharmacoeconomic, business development and strategic planning skills

• Excellent communication, presentation, vendor management and contract negotiation abilities

• Proven leadership experience managing teams, complex projects and cross-functional initiatives

• Ability to develop policies, implement operational workflows and ensure regulatory compliance

Pay Range:
The anticipated pay range for this position is $150,000-200,000 annually. We understand salary is an important factor in a job search, and we encourage you to apply even if you feel that your desired compensation may fall outside of the listed range. The final pay for this position is determined based on several factors including but not limited to, relevant experience, skills and certifications, education and training, geographic location, market conditions, and internal equity. We are committed to finding the right candidate for this role and are open to discussing how your unique qualifications align with our needs.

Contact:
Alexandria Van Riper
avanriper@jacobsongroup.com