Director of Pharmacy

About the role

The Director of Pharmacy will lead the strategic vision and operational execution of pharmacy benefits across multiple lines of business, including Medicare, Medicaid, Exchange, CHP+ and commercial plans. This senior leader ensures clinical excellence, financial sustainability, regulatory compliance and member‑centered outcomes while driving innovation in formulary governance and specialty pharmacy.

Key responsibilities

• Provide strategic oversight of pharmacy benefit operations, formulary strategy, benefit design and cost‑containment initiatives.
• Oversee Pharmacy Benefit Manager (PBM) performance, contract compliance and operational effectiveness.
• Lead formulary management, including specialty pharmacy, biosimilars, opioid safety, behavioral health integration and 340B strategy.
• Develop and implement utilization management protocols, prior authorization oversight and medication adherence programs.
• Manage pharmacy staff responsible for prior authorization, medication therapy management, care coordination and utilization review.
• Negotiate and manage PBM contracts, service level agreements, rebate programs and vendor performance metrics.
• Monitor pharmacy financial performance, rebate administration and budget management.
• Collaborate with quality, care management and member services teams to integrate pharmacy initiatives into broader population health strategies.
• Ensure compliance with Medicare, Medicaid, DOI, NCQA and other regulatory requirements.

Required profile

• Extensive experience in pharmacy benefit management and formulary governance.
• Proven leadership of cross‑functional teams and ability to influence executive stakeholders.
• Deep knowledge of Medicare, Medicaid, commercial and exchange pharmacy plans.
• Strong background in contract negotiation, vendor management and financial analysis.
• Demonstrated ability to drive quality improvement initiatives and meet regulatory metrics such as HEDIS, CAHPS and CMS Star Ratings.

Required skills