Director of Clinical & Pharmacy Strategy

Shaw-posted 1 day ago

Full-time • Director

Hybrid

501-1,000 employees

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Director of Clinical & Pharmacy Strategy will serve as Shaw’s enterprise expert in pharmacy benefits and medical plan design strategy. This role will lead a multi-year transformation of how Shaw manages pharmacy and medical benefits for 27K enrolled lives—modernizing plan structure, vendor partnerships, and data analytics to improve cost, quality, and experience. As a strategic thought partner to the Director of Health & Wellness and the Vice President of Total Rewards, this individual will develop and execute an integrated medical and pharmacy strategy that prioritizes affordability and health outcomes. The ideal candidate brings deep technical expertise in pharmacy benefit operations, clinical policy development, formulary and specialty drug management, and medical plan optimization. This position is ideal for a seasoned strategist who thrives at the intersection of clinical innovation, data analysis, and large-scale operational execution.

Lead the end-to-end redesign of Shaw’s pharmacy benefit management (PBM) and medical plan strategy, ensuring alignment with organizational objectives, financial sustainability, and associate well-being.
Develop and execute enterprise-level affordability strategies that integrate pharmacy, medical, and behavioral health data to identify trend drivers and create actionable solutions.
Design evidence-based plan modifications, including formulary optimization, specialty drug management, and clinical policy pathways that improve efficiency and reduce spend.
Serve as the company’s subject-matter expert in PBM contracting, plan design, and clinical policy; advise leadership on market trends, regulatory changes, and innovation opportunities.
Provides strategic leadership and oversight for compliance with all medical and pharmacy benefit plans, ensuring adherence to federal, state, and regulatory requirements.
Partner with team Analysts and Brokers to perform analyses of integrated claims and operational data (medical, pharmacy, lab, and authorizations) to identify cost and utilization trends, inform plan redesign, and evaluate vendor performance.
Partner with data and finance teams to calculate self-funded cost projections, trend forecasts, and contribution models.
Conduct competitor benchmarking and policy gap analyses to inform decision-making and ensure Shaw’s plans remain competitive and compliant.
Track and monitor clinical policy performance metrics and recommend evidence-based modifications to improve affordability and associate health outcomes.
Lead strategy and governance for Shaw’s PBM and medical carrier partners, ensuring performance excellence, transparency, and value.
Evaluate and recommend alternative third-party solutions that support population health management, value-based care, and integrated wellbeing initiatives.
Oversee renewals, RFPs, and negotiations with carriers and PBMs, including modeling financial impact and ensuring alignment with enterprise goals.
Evaluate opportunities in specialty, ambulatory, infusion, and onsite pharmacy services, as well as carve-out models, to improve access and affordability.
Integrate pharmacy and medical plan strategy with Shaw’s Onsite Clinics, behavioral health, and wellness programs for a unified Total Rewards experience.
Develop and maintain partnerships with external experts, consultants, and industry groups to stay ahead of regulatory, innovation, and policy trends.

Bachelor’s degree in Business, Human Resources, Pharmacy, Health Administration, Public Health, or related field required.
Minimum of 15 years of progressive experience in pharmacy benefit management, medical plan design, or healthcare strategy, with demonstrated leadership in PBM contracting and cost optimization.
Deep knowledge of healthcare policy, compliance (ACA, ERISA, HIPAA).
Proven ability to conduct complex data analyses and translate findings into actionable recommendations for leadership.
Exceptional communication and influencing skills; comfortable presenting to senior executives, finance leaders, and cross-functional partners.
Hands-on operator with strong strategic acumen—able to balance long-term transformation with immediate execution.
Demonstrated success managing large-scale projects, leading through ambiguity, and achieving measurable outcomes in affordability, access, and associate health.
Limited travel necessary (likely two to four times annually).
High level of confidentiality.

Experience leading pharmacy carve-out evaluations, PBM transitions, or 340B program strategy.
Background in self-funded plan management, value-based design, and integrated clinical analytics.

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