Job Details

Job Description:
A strategic leadership role overseeing pharmacy benefits for a major health plan is available. This position requires guiding the vision and operational execution of pharmacy benefits to ensure alignment with clinical excellence, financial sustainability and member-centric outcomes. Responsibilities include managing the entire pharmacy benefit design, oversight, and performance management across various lines of business including Medicare, Medicaid, CHIP+, exchange and commercial plans. The leader will collaborate with multiple departments to optimize medication access, adherence, and cost savings, leveraging Pharmacogenomics principles and industry trend analysis to inform strategic decisions. The role involves leading a team to monitor pharmacy cost and utilization data, ensuring compliance with applicable laws and regulations, and driving ongoing improvements in pharmacy services and efficiencies.

Responsibilities:

• Lead the strategic vision and operational execution of pharmacy benefits ensuring compliance with federal, state, and local laws and regulations.
• Manage end-to-end pharmacy benefit design, including formulary strategy and PBM partnerships.
• Oversee performance management across all lines of business, aiming for clinical excellence, financial sustainability and member satisfaction.
• Collaborate with departments to optimize medication access, adherence and achievement of cost savings goals.
• Utilize pharmacogenomics principles and industry trend evaluations to guide pharmacy policy and practice improvements.
• Monitor pharmacy cost, utilization data and industry benchmarks to inform business strategies.
• Lead and develop a team to review, analyze, and implement pharmacy initiatives and policy updates.
• Ensure compliance with Medicaid, Medicare, DOI and other regulatory requirements, developing new policies as needed.
• Manage relationships with vendors and negotiate contracts to maximize value and service excellence.
• Provide clear updates and reports to executive leadership on pharmacy performance and strategic initiatives.

Requirements:

• Doctorate degree Doctor of Pharmacy (PharmD)
• 5+ years administrative pharmacy department management experience within a managed care organization, PBM, Medicaid and/or Medicare program in a leadership role
• 1+ years director level or higher management experience including administrative, supervisory, regulatory, contract, rebate management and program development duties (preferred)
• PHA-Licensed Pharmacist - DORA - Department of Regulatory Agencies
• Strong analytical, business development, pharmacoeconomic and critical thinking skills
• Excellent verbal and written communication skills
• Proven ability in contract negotiation, vendor management, presentation and training
• Ability to multi-task, develop regulatory guidelines, prioritize, delegate and implement operational workflows
• Industry experience with claims adjudication, NCPDP standards, MTM, NCQA, HEDIS, formulary management, provider networks, prior authorization, drug utilization review, and application of commercial, Medicare, Medicaid and CHIP+ programs
• Ability to identify policy needs and develop or review required documentation
• Demonstrated leadership in managing cross-functional teams and multiple complex projects

Pay Range:
The anticipated pay range for this position is $85.00 - $85.00 per hour. 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.

Benefits:

• Medical insurance
• Dental insurance
• Vision insurance
• 401(k) retirement savings plan

Contact:
Karrie Ruch
kruch@jacobsongroup.com

Equal Opportunity Employer:
The Jacobson Group is committed to fostering an inclusive and equitable workplace that reflects the diverse communities we serve. We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, veteran status or any other protected characteristic as defined by applicable law. We believe that diversity of thought, background and experience strengthens our team and drives innovation. All employment decisions are based on qualifications, merit and business needs. If you require a reasonable accommodation to complete the application process or participate in an interview, please contact us at HR@jacobsongroup.com or +1 (800) 466-1578 to make a request.

Refer a Colleague:
Do you know someone who would be interested in this project? Submit your referral directly by emailing the Jacobson contact listed above or submitting them through this form. If your referral is hired for a contract assignment and meets all other eligibility criteria, you will receive a referral bonus!