Director, Pharmacy Clinical Operations - Emory Health Plan

Emory University•Atlanta, GA

10h

About The Position

Director of Pharmacy, Clinical Operations - Emory Health Plan is responsible for driving clinical excellence, evidence-based medication management, and stewardship of pharmacy spend across enterprise plan's membership.

Requirements

Doctor of Pharmacy (PharmD) from an accredited School of Pharmacy.
At least 5 years of clinical pharmacy, managed care, or health system experience and 5 years of leadership experience.
Strong knowledge of drug therapy, formulary management, evidence evaluation, and population health principles.
Experience preparing drug monographs, MUEs, or P&T materials.
Ability to engage effectively with physicians, clinical leaders, and multidisciplinary teams.
Strong analytical and communication skills.

Nice To Haves

Completion of PGY1 residency preferred in managed care or PGY-2 in ambulatory care, population health, or pharmacotherapy.
Prior experience within a health plan, PBM, IDN, or specialty pharmacy setting.
Experience with utilization management criteria, outcomes measurement, or quality improvement programs.
Familiarity with medical + pharmacy benefit integration and specialty drug management.

Responsibilities

Leads medication use evaluations (MUEs), prepares clinical materials for the Pharmacy & Therapeutics (P&T) Committee, develops strategies that improve quality outcomes, and serves as a liaison to Emory physicians, service lines, and clinical leaders.
Supports both clinical and financial performance by identifying opportunities for optimized utilization, implementing evidence-based initiatives, and advancing EHP's integrated care model.
Leads Medication Use Evaluations (MUEs) across high-cost, high-impact therapeutic categories (e.g., specialty, chronic disease, oncology, immunology).
Identifies medication-related trends, quality gaps, and opportunities for improved clinical management.
Develops clinical strategies that enhance outcomes, reduce unwarranted variation, and promote safe, cost-effective prescribing.
Evaluates new therapies, guidelines, and pipeline agents to inform proactive benefit and policy decisions.
Prepares, reviews, and presents clinical materials for the Pharmacy & Therapeutics Committee, including drug monographs, comparative evidence reviews, formulary recommendations, and safety updates.
Ensures clinical recommendations reflect best available evidence, Emory clinical pathway alignment, and financial stewardship considerations.
Maintains documentation, committee records, and formulary reference materials.
Partners with UM teams to design and refine prior authorization criteria, step therapy pathways, and clinical edits.
Monitors utilization patterns, adherence trends, prescribing behaviors, and opportunities for quality improvement.
Leads development of clinical care pathways, disease state strategies, and population health pharmacy programs (e.g., cardiometabolic, immunology, rare disease).
Supports HEDIS, STARs, and internal quality initiatives through pharmacy-focused interventions.
Serves as the primary pharmacy liaison with Emory physicians, clinical service lines, ambulatory care teams, and population health leaders.
Collaboratively develops evidence-based approaches to improve prescribing, optimize specialty drug use, and support value-based care initiatives.
Provides clinical guidance to EHP leadership, including interpretation of therapeutic evidence, quality metrics, and medication policy impacts.
Identifies opportunities to reduce avoidable pharmacy and medical spend while maintaining or improving clinical outcomes.
Conducts cost-effectiveness analyses, total cost of care reviews, and ROI assessments for pharmacy programs.
Collaborates with analytics and finance partners to track specialty drug trend, high-cost member impact, and budget performance.
Supports integration of medical + pharmacy benefit strategies to improve care alignment and financial sustainability.
Partners closely with PBM teams, Emory Specialty Pharmacy, ambulatory pharmacy operations, care management, and population health teams. Supports implementation of new benefit designs, formulary changes, and clinical programs.
Contributes to EHP governance committees, physician advisory groups, and enterprise clinical initiatives.