Director, Pharmacy Strategy and Performance
About The Position
The Director, Pharmacy Strategy and Performance leads a team responsible for developing and executing enterprise pharmacy strategy across pharmacy and medical benefits. The role oversees drug and network contracting, contract performance, and financial performance across provider-administered drugs, home infusion, and retail and specialty pharmacy networks. The Director partners with Pharmacy Clinical Leadership, Medical Management, Finance, Actuary, Provider Contracting, and external pharmacy benefit management partners to improve drug trend management and maximize value for members, clients, and the organization. The position reports to the Vice President, Pharmacy Performance. The role requires leadership in developing affordability and value-based strategies, managing enterprise drug contracting, designing reimbursement and site-of-care approaches, and directing network performance. It also involves using analytics and financial models to evaluate utilization, trends, savings opportunities, and program effectiveness, then communicating results and recommendations to senior leaders and other stakeholders. This is a hybrid role. For most teams, the workplace model means working in the office two days each week. Employees living more than 50 miles from an office location will work with their manager to determine in-office time based on business need. The work is primarily sedentary office and desk work.
Requirements
- Currently active and unrestricted California Registered Pharmacist (RPh) license.
- Doctor of Pharmacy (PharmD) degree from an accredited U.S. school of pharmacy.
- 10 years of prior relevant experience in a managed care health plan, pharmacy benefit management company, or other relevant setting.
- 6 years of prior people management experience with direct responsibility for supervising, coaching, and evaluating direct reports.
- Excellent communication skills and prior experience presenting to internal and external executive-level business stakeholders.
- Knowledge of pharmacy benefits, formulary, and network programs for drugs covered under pharmacy and medical benefits.
- Strong business acumen and proven experience in pharmacy strategy development and planning.
- Excellent presentation, verbal, and written skills, including the ability to understand and convey complex ideas to audiences with diverse backgrounds.
- Detail-oriented and able to work in a fast-paced environment.
- Can-do attitude and solution-oriented approach to resolving challenges.
Nice To Haves
- Prior experience in vendor partnership, contract operations, negotiations, and performance management.
Responsibilities
- Lead development and execution of pharmacy affordability and value-based strategies across pharmacy and medical drug spend, taking industry trends, market dynamics, regulatory changes, and the competitive landscape into account.
- Evaluate industry trends, market dynamics, and the competitive landscape to inform strategic decisions.
- Own enterprise drug contracting strategy across pharmacy and medical benefits, including manufacturer agreements, rebate contracting, value-based and outcomes-based arrangements, financial guarantees, and contract performance.
- Lead contracting and affordability strategies for drugs covered under the medical benefit, including provider-administered drugs and specialty therapies, in partnership with Provider Contracting and Network Management.
- Design and implement reimbursement and site-of-care strategies that promote delivery in clinically appropriate, cost-effective settings.
- Establish strategic direction, contracting requirements, and performance oversight for pharmacy and medical benefit networks, including retail, specialty pharmacy, home infusion, mail order, ancillary pharmacy, and provider networks supporting provider-administered drugs.
- Monitor financial, operational, access, and quality performance using key performance indicators and contractual guarantees, and evaluate emerging network designs and alternative drug distribution models.
- Develop business cases and financial models for pharmacy strategic initiatives, monitoring pharmacy trend, rebate performance, medical drug spend, and network economics.
- Use data analytics to evaluate utilization patterns, identify savings opportunities, and measure program effectiveness.
- Present performance results and strategic recommendations to senior leadership and executive stakeholders.
- Build partnerships with internal stakeholders, PBM leadership, providers, pharmaceutical manufacturers, and industry organizations.
- Supervise, coach, and evaluate direct reports.
Stand Out From the Crowd
Upload your resume and get instant feedback on how well it matches this job.
What This Job Offers
Job Type
Full-time
Career Level
Director
Education Level
Ph.D. or professional degree
