- Develops, prioritizes, implements, and optimizes pharmacy quality, affordability, and medication management programs, including Medicare Stars, HEDIS, and other clinical initiatives.
- Identifies opportunities to improve program performance, member outcomes, and operational effectiveness.
- Builds partnerships and leads cross-functional initiatives involving Pharmacy, Quality, Analytics, Product, Provider Enablement, Care Management, Operations, Network Management, and external vendors to achieve organizational goals.
- Assures service levels and activities meet client service level agreements, as well as contractual obligations and compliance, such as state, federal, and CMS regulations or specific member contracts, with service guarantees.
- Provides routine and/or intermittent reporting and analysis as appropriate of clinical program activities that fall under their oversight.
- Ensure continuous quality assurance inclusive of documented policies, procedures, and workflows for all programs.
- Provides leadership and mentorship to direct reports, including clinical and non‑clinical staff, through development and tracking of performance goals and objectives, as well as through quarterly performance conversations.
- Prioritizes and manages work activities of clinical pharmacist consultant staff.
- Collaborates with the Pharmacy Directors, VPs, and other leadership in coordinating corporate‑wide activities related to the appropriate use of medications, improved quality related to medication therapy, promotion of cost‑effective prescribing, and reduction in short‑term and long‑term overall costs to internal and external clients.
- Provides strategic oversight of assigned vendor relationships, including implementation, performance monitoring, governance, operational optimization, and evaluation of new opportunities that support organizational priorities.
- Identifies emerging trends, regulatory changes, and innovation opportunities that improve quality outcomes, affordability, member experience, and business performance.
- Handles all management level responsibilities for staff, hiring, firing, coaching, counseling, and retention.
- Manages financial targets and department budget, authorizes expenditures, monitors workforce allocation and resources, and oversees project plans.
Requirements
- Bachelor's degree in Pharmacy or Pharm.D; Residency certificate or advanced degree in health care administration, economics, public health, pharmacy administration, finance, or equivalent field preferred.
- Minimum 3 years of experience in patient care setting as well as management or professional business experience in a managed health care system, medical group, hospital, or related business in health care delivery industry or an equivalent combination of education and experience.
- Licensed pharmacist in state of practice.
- Strong clinical pharmacy background with ability to demonstrate clinical therapy skills and knowledge.
- Strong business acumen, knowledge of health care economics and financing, health care and PBM industry dynamics, benefit design, provider contracting strategies, techniques, and operational processes.
- Demonstrated ability to develop and execute strategic initiatives, identify opportunities for innovation, and translate complex business challenges into actionable solutions.
- Experience managing external vendors, consultants, or strategic partners, including performance monitoring, operational governance, implementation oversight, and issue resolution.
- Demonstrated success influencing stakeholders and leading cross‑functional initiatives in a matrixed environment.
- Ability to build partnerships, align priorities, and drive results across multiple business areas without direct authority.
- Excellent verbal and written communication skills; strong business analytical skills and abilities; project management and coordination ability; ability to function effectively as a management team member.
- Demonstrated ability to review and analyze data from medication claims, recommending programs and policies to encourage appropriate utilization.
- Ability to select, train and lead staff, manage resources and prioritize workload.
Core Competencies
Demonstrates expertise in pharmacy quality management, medication therapy optimization, and compliance with regulatory standards. Proven ability to lead cross‑functional teams, manage vendor relationships, and drive strategic initiatives to enhance patient outcomes and operational efficiency.
Highest-signal resume keywords
- Licensed Pharmacist
- Clinical Pharmacy Background
- Health Care Economics Knowledge
- Vendor Management Experience
- Strategic Initiative Development
ATS Optimization Keywords
Hard Skills
- Medication Management Programs
- Quality Assurance
- Data Analysis
- Project Management
- Performance Monitoring
Soft Skills
- Excellent Communication Skills
- Stakeholder Influence
- Team Leadership
- Partnership Building
- Business Acumen
Certifications & Qualifications
- Bachelor's Degree in Pharmacy
- Pharm.D
- Residency Certificate
Industry Keywords
- Medicare Stars
- HEDIS
- Managed Health Care
- Clinical Initiatives
- Provider Contracting Strategies