Pharmacy Director - Health Plan

About this Job: General Summary of Position
The Director of Pharmacy provides strategic leadership and operational oversight for pharmacy benefit management formulary strategy medication utilization and pharmacy quality initiatives across the health plan. This role is responsible for ensuring safe cost effective and evidence-based medication use while supporting regulatory compliance value-based care initiatives and population health goals. The Director collaborates with clinical leadership pharmacy benefit managers (PBMs) providers and health plan operations to optimize pharmacy programs that improve patient outcomes and manage total cost of care.

Primary Duties and Responsibilities

• Develop and implement the health plan pharmacy strategy aligned with organizational goals and population health priorities.
• Lead formulary management pharmacy policy development and medication utilization management programs.
• Provide oversight of pharmacy benefit design and cost containment initiatives.
• Manage relationships with pharmacy benefit managers (PBMs) and specialty pharmacy vendors.
• Oversee formulary development rebate programs contract performance and pharmacy network management.
• Monitor pharmacy benefit performance metrics and implement improvement initiatives.
• Direct programs such as: Prior authorization step therapy medication therapy management (MTM) specialty pharmacy management
• Ensure clinical programs are evidence based and aligned with national guidelines and regulatory requirements.
• Ensure compliance with CMS NCQA state regulations and accreditation standards related to pharmacy services.
• Support Medicaid pharmacy program requirements as applicable.
• Lead pharmacy-related quality initiatives and performance reporting.
• Use pharmacy claims and clinical data to: Identify utilization trends manage drug spend support value-based care models.
• Develop dashboards and reporting to monitor pharmacy performance indicators.
• Collaborate with physicians pharmacists and care management teams to optimize medication use.
• Serve as a subject matter expert on pharmacy policy and medication management.
• Support provider education on formulary updates and pharmacy programs.
• Recruit develop and supervise pharmacy and clinical staff.
• Foster a culture of collaboration accountability and continuous improvement.
• Minimal Qualifications
  Education
  • Bachelor's degree Graduate training in an accredited College of Pharmacy. required
  • Doctoral degree Doctor of Pharmacy (PharmD) required
  • Advanced degree (MBA MPH MHA) preferred
  Experience
  • 8-10 years Pharmacy leadership experience required
  • Significant experience in health plan pharmacy PBM operations or managed care pharmacy required
  • Experience with Medicare Part D Medicaid or commercial pharmacy benefitspreferred Certifications required
  Licenses and Certifications
  • PharmD - licensed pharmacist in the District of Columbia or eligibility for reciprocity upon hire (required) Upon Hire required
  • BCPA-Board Certified Patient Advocate Board Certification (e.g. BCPS BCACP) preferred
  • PTCB - Pharmacy Technician Certification Board Board Certification (e.g. BCPS BCACP) preferred
  • PHARMACOTH - Board Certified Pharmacotherapy Specialist Board Certification (e.g. BCPS BCACP) preferred
  Knowledge Skills and Abilities
  • Managed care pharmacy expertise
  • Pharmacy benefit design and formulary management
  • Regulatory and accreditation knowledge (CMS NCQA)
  • Financial and utilization analytics
  • Strategic leadership and change management
  • Stakeholder collaboration and communication
  • Pharmacy cost trend and total drug spend
  • Medication adherence and quality metrics
  • Formulary compliance and utilization management outcomes
  • PBM contract performance
  • Regulatory and accreditation compliance
  This position has a hiring range of : USD $161,158.00 - USD $348,296.00 /Yr.