Location: Indianapolis, IN (Onsite preferred, Remote will be considered)
Department: Clinical Services
Reports To: Vice President, PBM (Pharmacy Benefit Manager) and Clinical Blueprints
Position Summary
Northwind Health is seeking an experienced, innovative, and strategic Director of Clinical Strategies to lead the organization's pharmacy benefit management operations and multidisciplinary clinical team. This leadership role is responsible for integrating clinical programs into the PBM operations to improve health outcomes while reducing total healthcare costs for self-funded employers, labor organizations, and health plans.
The Director will oversee PBM operations, quality improvement initiatives, and clinical staff development. The ideal candidate combines deep clinical expertise with business acumen, leadership experience, and a passion for transforming healthcare through data-driven population health strategies.
Key Responsibilities
Clinical Leadership & Strategy
- Execute Northwind Health's clinical strategy aligned with organizational growth objectives.
- Lead the integration of PBM operations with clinical programs focused on:
- Diabetes management
- Weight management and obesity
- GLP-1 optimization
- Medication optimization
- Polypharmacy management
- Preventive health and chronic disease management
- Ensure programs are evidence-based and aligned with national clinical guidelines and quality standards.
- Monitor clinical outcomes and identify opportunities for innovation and improved performance.
Clinical Operations
- Direct day-to-day operations of pharmacists, prior authorization team, care coordinators, and other clinical staff.
- Develop staffing plans to support organizational growth.
- Monitor productivity, quality metrics, member satisfaction, and operational efficiency.
- Ensure regulatory compliance with state and federal healthcare requirements, HIPAA, and pharmacy regulations.
PBM Operations
- Lead Northwind's PBM operations focused on improving clinical value while reducing unnecessary pharmacy spend.
- Collaborate with PBM partners on:
- Formulary optimization
- Medication adherence initiatives
- Specialty pharmacy management
- DUR review and risk mitigation
- Waste, fraud, and abuse mitigation
- Analyze pharmacy claims and utilization data to identify opportunities for improved outcomes and cost savings.
- Evaluate emerging therapies and develop clinical recommendations for implementation.
- Foster a culture of accountability, collaboration, innovation, and continuous improvement.
- Conduct performance evaluations and support professional development.
- Promote interdisciplinary collaboration across clinical, operations, sales, technology, and account management teams.
Business Development & Client Engagement
- Provide clinical expertise during sales presentations and client meetings.
- Support proposal development, RFP responses, and implementation planning.
- Build trusted relationships with employer groups, consultants, brokers, health plans, and provider organizations.
- Present clinical outcomes, ROI analyses, and program performance to executive stakeholders.
Leadership Responsibilities
- Lead and inspire a multidisciplinary clinical team.
- Develop departmental goals and budgets.
- Establish clinical performance metrics and accountability measures.
- Drive organizational growth through scalable clinical operations.
- Champion innovation in digital health, telehealth, remote monitoring, and pharmacist-led care models.
Qualifications
Required
- Doctor of Pharmacy (PharmD) from an ACPE-accredited institution.
- Minimum of 5 years of progressive clinical leadership experience.
- Minimum of 3 years managing clinical teams.
- Experience with PBMs, managed care, employer health plans, or population health programs.
- Strong knowledge of:
- Diabetes management
- GLP-1 therapies
- Cardiovascular disease prevention
- Weight management
- Medication therapy management
- Excellent communication and executive presentation skills.
Preferred
- Board Certification (BCACP, BCPS, BC-ADM, BCMTMS, or similar).
- Certified Diabetes Care and Education Specialist (CDCES).
- Experience supporting self-funded employer populations.
- Knowledge of value-based care and alternative payment models.
- Experience working with healthcare analytics platforms and clinical reporting tools.
Why Northwind Health?
Northwind Health partners with employers, health plans, and labor organizations to deliver clinically integrated population health solutions that improve outcomes while reducing total healthcare costs. Our innovative approach combines personalized care, advanced analytics, pharmacy optimization, and evidence-based clinical interventions to help members achieve lasting health improvements and deliver measurable value to our clients.
As Director of Clinical Strategies, you will play a key leadership role in shaping the future of Northwind Health's clinical programs, expanding PBM influence and innovative care models, and improving the lives of the populations we serve.
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