Director, Pharmacy - Denver Health Medical Plan ( Hybrid Work Schedule )

Denver Health•Denver, CO

23h•Hybrid

About The Position

The Director of Pharmacy for Denver Health Medical Plan (DHMP) leads the strategic vision and operational execution of pharmacy benefits, ensuring alignment with clinical excellence, financial sustainability, and member-centric outcomes. This role manages end-to-end pharmacy benefit design, oversight, and performance management across the entire health plan ecosystem, from formulary strategy and Pharmacy Benefit Manager (PBM) partnership to member experience and quality improvement. The position bridges clinical rigor with business impact, managing multiple lines of business including Medicare, Medicaid, CHP+, Exchange, and Commercial plans. Working collaboratively with other departments, the Director drives optimization of medication access, adherence, and cost savings. Utilizing Pharmacogenomics principles and evaluating industry trends, the Director leads a team to review, analyze, and monitor pharmacy cost and utilization data to inform and execute on short-term and long-term business goals, all in accordance with Federal, State, and local laws and regulations.

Requirements

Doctorate degree Doctor of Pharmacy (PharmD)
Minimum of 5 years administrative Pharmacy Department management experience within a Managed Care Organization, PBM, Medicaid, and/or Medicare Program in a leadership role
PHA-Licensed Pharmacist - DORA - Department of Regulatory Agencies
Analytical, Business Development, Pharmacoeconomic and Critical thinking skills
Excellent verbal/written communication, contract negotiation, vendor management, presentation, training and organizational skills
Ability to multi-task, develop regulatory guidelines, prioritize, delegate, create and implement standardized processes and operational workflow
Industry experience with claims adjudication, NCPDP standards, Medication Therapy Management (MTM), NCQA, HEDIS, Pharmacy Benefit design, Formulary management, Provider Networks, Prior Authorization Management, Drug Utilization Review, Customer Service and application of Commercial Health, Medicare, Medicaid and CHP+ programs including regulatory requirements
Able to identify the need for new policies and procedures to meet Medicaid, Medicare and Department of Insurance (DOI) requirements as well as write and review existing documentation
Proven ability to lead cross-functional teams and manage multiple complex projects, and provide clearly articulated updates to Executive Leadership

Nice To Haves

1-3 years Director level or higher management experience including: administrative, direct supervisory, regulatory, contract, rebate management and program development duties

Responsibilities

Provides strategic oversight of all pharmacy functions, including Pharmacy Benefit Manager (PBM) performance, formulary strategy, benefit design, and cost containment.
Oversees formulary management and 340B program strategy, including specialty drug utilization, biosimilar uptake, opioid safety, and behavioral health pharmacy integration.
Designs and implement pharmacy financial incentive programs, such as prescriber performance bonuses, shared savings models tied to utilization efficiency, outcomes-based rebate innovation, and value-tiered network designs to improve access and affordability.
Designs utilization management protocols that enhance formulary compliance through prior authorization oversight of both outpatient and medical pharmacy.
Provides oversight of the Pharmacy & Therapeutics (P&T) Committee, ensuring formulary governance, clinical alignment, and rapid adoption/evaluation of emerging therapies.
Oversight of diverse Pharmacy Department staff who manage prior authorization review, utilization management protocols, care coordination, Medication Therapy Management (MTM), and medication adherence services.
Sets clear expectations for staff by developing job specific customer service expectations and behaviors for each position supervised; clearly communicates expectations to each employee and establishes the expectations as job requirements and performance appraisal components; delegates responsibility/authority whenever possible.
Conducts all performance evaluations on time, working with each employee at least annually to set specific behavioral goals.
Defines role-based expectations, facilitates training, promotes retention, and supports staff development.
Foster positive employee engagement inclusive of departmental collegiality and organizational belonging.
Negotiate and manage PBM contract with explicit quality and performance targets, ensuring alignment with health plan clinical, regulatory, and cost-saving objectives.
Assists in rebate and budget development, processing and monitoring.
Negotiates Service Level Agreements (SLAs) and contract terms in coordination with Legal, Finance, and operational leaders. This includes overseeing any new Request for Proposals (RFP) or contract re-negotiations with the PBM.
Monitors vendor performance against defined metrics and escalates gaps for resolution.
Collaborate with quality, care management and member services to integrate pharmacy data into holistic health strategies.
Development and implementation of strategies for the evaluation, performance and enhancement of current and new pharmacy programs including Medication Adherence Programs and Disease Management.
Monitors the managed care pharmacy industry, Health Care Reform and pharmacy benefit design trends to identify new business opportunities and improve the quality and cost effectiveness of the current DHMP Pharmacy program.
Evaluates priorities, performance measures, pharmacy cost metrics and savings opportunities for DHMP using LEAN principles.
Collaborate with Quality Improvement team to support performance on measures including CAHPS, HEDIS, CMS Star Ratings and other value-based metrics related to pharmaceutical use.
Set, track and report on pharmacy department operational performance goals to meet or exceed Quality metrics and DOI regulatory requirements.
Compiles data and analysis to for the NCQA accreditation process.
Prepares and presents monthly, quarterly, annual and ad-hoc reports upon request.
Maintain internal policies and procedures which meet regulatory compliance and industry standards.
Reviews and communicates cost control measures, department objectives and effectiveness, as well as personnel productivity to promote organizational goals.
Directs special financial, operational, regulatory, case management, quality, technology and other projects and programs as assigned.
Serves as a voting member of DHMP Compliance, QIC, Medical Management, Network Management, and P&T committees.
Maintains bidirectional communication with executive leadership highlighting progress on strategic goals and any challenge areas.
Ensures alignment with Denver Health Medical plan (DHMP) and Denver Health Hospital Authority (DHHA) business priorities.

Benefits

Paid time off starting at 28 days per year, inclusive of vacation, personal/sick, and 7 Holidays
100% paid parental leave up to 6 weeks
Immediate eligibility for retirement plans with employer contribution up to 9.5%
Generous medical, dental, vision plans in addition to employer paid disability and life insurance
Comprehensive well-being programs including on-site employee fitness center located on Denver Health main campus and nationally recognized RESTORE Center
Free RTD EcoPass (public transportation)
Childcare discount programs & exclusive perks on large brands, travel, and more
Tuition reimbursement & assistance
Education, coaching, and professional development opportunities through the Workforce Development Center (WFDC) that support internal career growth and advancement pathways
Professional clinical advancement program & shared governance
Public Service Loan Forgiveness (PSLF) eligible employer+ free student loan coaching and assistance navigating the PSLF program
National Health Service Corps (NHCS) and Colorado Health Service Corps (CHSC) eligible employer