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Job description
About the 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 benefits preferred Certifications required
Licenses and Certifications PharmD - licensed pharmacist in the District of Columbia and Maryland or eligibility for reciprocity 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.
Worksite address
columbia, MD, 21046, US
Who can apply
Review the original listing for work authorization, qualifications and employer requirements.