Director of Medical & Pharmacy Strategy

Shaw

5d•Hybrid

About The Position

The Director of Medical & Pharmacy Strategy will lead Shaw’s enterprise benefits management, plan design, and vendor/contract strategy for medical and pharmacy programs covering 27,000+ enrolled lives. This highly strategic role requires deep expertise in benefits operations, plan optimization, contract negotiation, and partnership with brokers/consultants. The ideal candidate will have a proven track record in leading large-scale benefits programs, managing complex vendor relationships, and driving cost and quality improvements through data-driven plan design. 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. This position is ideal for a seasoned strategist who thrives at the intersection of innovation, data analysis, large-scale execution, and thoughtful policy design.

Requirements

Bachelor’s degree in Business, Human Resources, Pharmacy, Health Administration, Public Health, or related field required.
Minimum of 15 years of progressive experience in benefits management, health plan operations, or pharmacy benefit management, with demonstrated leadership in contracting, vendor management, and cost optimization.
Experience leading and managing program contract negotiations.
Deep knowledge of healthcare policy and 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.
Limited travel necessary (likely two to four times annually).
High level of confidentiality.

Nice To Haves

Experience leading medical/pharmacy consultants and brokers.
Strong background in self-funded plan management, value-based benefit design, and integrated medical and pharmacy analytics.
Proven experience leading medical plan and pharmacy benefit evaluations, transitions, and overall program strategy.

Responsibilities

Lead the strategy and redesign of Shaw’s medical and pharmacy benefit programs, ensuring alignment with organizational objectives, financial sustainability, and associate well-being.
Develop and execute enterprise affordability strategies by integrating medical, pharmacy, and behavioral health data to identify trend drivers and implement actionable solutions.
Serve as the enterprise subject-matter expert for medical and pharmacy plan design, contracting, and policy, advising leadership on market trends, regulatory changes, and innovation opportunities.
Design and implement evidence-based plan modifications—including formulary optimization, specialty drug management, and clinical policy pathways—to improve efficiency and reduce spend.
Provide leadership and oversight to ensure compliance with all federal, state, and regulatory requirements of medical/pharmacy benefit plans.
Lead contract negotiations, renewals, and RFPs with medical carriers, PBMs, and third-party vendors to ensure alignment with enterprise objectives and financial targets.
Synthesize complex data through claims, policy, and market analyses to deliver recommendations for plan design, cost management and utilization.
Partner with and lead external brokers and consultants to analyze cost and utilization trends, benchmark plan performance, evaluate vendor selection, and drive strategic plan redesign.
Collaborate with data and finance teams to develop self-funded cost projections, trend forecasts, and contribution modeling.
Conduct competitor benchmarking and policy analyses to ensure plan competitiveness, compliance, and market alignment.
Monitor performance metrics and recommend evidence-based plan and vendor modifications to improve affordability and health outcomes.
Lead strategy and governance for Shaw’s medical carrier and PBM partners, ensuring performance excellence, transparency, and value.
Evaluate and recommend alternative third-party, value-based, and carve-out solutions across ambulatory, infusion, specialty, and onsite services to improve access, affordability, and population health outcomes.
Integrate medical and pharmacy strategies with Shaw’s onsite clinics, behavioral health, and wellness programs to deliver a cohesive Total Rewards experience.
Develop and maintain partnerships with external experts, consultants, and industry groups to stay ahead of regulatory, innovation, and policy trends.