Senior Director, Pharmaceutical Services

OverviewWhat you can expect!  Find joy in serving others with IEHP! We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an authentic experience!Reporting to the Vice President, Pharmacy, the Senior Director, Pharmaceutical Services leads the strategic direction, clinical oversight, and operational execution of IEHP’s pharmaceutical program for IEHP Medi Cal, DSNP, and Exchange members, and is responsible for ensuring appropriate utilization management through evidence based UM criteria, audit ready documentation, and strengthened cost containment protocols.

The role demonstrates advanced expertise in CMS, DHCS, DMHC, MDV audits and NCQA survey readiness and oversight, leading corrective action implementation and continuous quality improvement, while maintaining comprehensive regulatory compliance across DHCS, DMHC, CMS and NCQA. In addition, the Senior Director oversees the optimization of Pharmacy Benefit Management (PBM) performance, drives cost effective utilization, enhances member health outcomes, and ensures coordination of benefits and services with the DHCS Medi Cal Rx PBM, supporting IEHP’s strategic plans to improve chronic/preventative care, member experience, HEDIS, Stars and CAHPS performance.Commitment to Quality: The IEHP Team is committed to incorporate IEHP’s Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation.Additional BenefitsPerksIEHP is not only committed to healing and inspiring the human spirit of our Members, but we also aim to match our team members with the same energy by providing prime benefits and more.Competitive salary.Hybrid schedule. State of the art fitness center on-site.Medical Insurance with Dental and Vision.Life, short-term, and long-term disability optionsCareer advancement opportunities and professional development.Wellness programs that promote a healthy work-life balance.Flexible Spending Account – Health Care/ChildcareCalPERS retirement457(b) option with a contribution matchPaid life insurance for employeesPet care insuranceKey ResponsibilitiesDevelop and execute enterprise pharmacy strategies across Medi-Cal, Medicare, and Exchange, collaborating with executive leadership to integrate these strategies into clinical care models, value-based initiatives, and broader departmental priorities, including operations, quality, and clinical programsLead initiatives to improve medication adherence, clinical outcomes, cost efficiency, and overall pharmacy quality performanceEnsure compliance with CMS, DHCS, DMHC and all federal/state regulatory requirements governing pharmacy benefitsOversee pharmacy policy development, ensuring alignment with evolving regulations and industry best practicesServe as the organization’s pharmacy compliance lead, ensuring audit readiness and fulfillment of regulatory deliverablesManage PBM and vendor relationships, including contract negotiation, performance programs to maximize clinical and financial valueMonitor formulary, rebate, and utilization management programs to maximize clinical and financial valueEnsure PBM performance metrics align with pricing strategy, member satisfaction, and health outcomesDirect pharmacy operations and clinical programs, including MTM, prior authorization, grievance and appeals, and performance measuresLeverage data analytics to identify trends, cost drivers, and care improvement opportunitiesDrive access and affordability initiatives, particularly for vulnerable populationsEstablish and monitor productivity metrics to support operational excellence and staff performanceEnsure adherence to departmental and organizational policies, procedures, and standardsPartner cross-functionally with Quality, Provider Services, Case Management, Finance, and Actuarial to support innovation and integrated care deliveryRepresent the pharmacy department in cross-functional leadership forums, regulatory meetings, and industry engagementsHire, train, and manage support staff, while monitoring and evaluating outcomes. Conduct performance reviews of each Team Member within IEHP guidelinesPerform any other duties as required to ensure Health Plan operations and department business needs are successfulQualificationsEducation & Requirements  At least ten (10) years of experience in:-Leading the strategic direction, operational efficiency, and financial performance of the pharmacy department. This role encompasses various responsibilities, including leading teams, managing budgets, ensuring compliance, and driving quality improvement initiativesSenior level management, policy development and decision-making, with development and implementation of management best practicesSenior level management of a pharmacy benefit program spanning Medicare, Medi-Cal and ExchangePharmacy Benefit Management (PBM) oversight (CMS and Commercial)Clinical knowledge in implementing quality and clinical pharmaceutical programs (CMS star rating programs, DHCS MCAS measure improvement, NCQA quality programs)Leading and directing a team of clinical and operational pharmacists, pharmaceutical technicians, analysts, and special program managersAnnual budget managementPast successes in:Identifying trends or changes in treatment patterns and developing / implementing program changes to accommodate treatment changesImplementing innovative cost containment policies and proceduresImplementing quality assurance programsEmpowering staff to succeed through education and appropriate workPharm. D. from an accredited institution requiredMBA from an accredited institution preferredPossession of an active, unrestricted, and unencumbered Registered Pharmacist license issued by the California State Board of Pharmacy requiredKey QualificationsComprehensive knowledge of:CMS, DHCS, DMHC and NCQA pharmacy regulationsBusiness principles and techniques of administration, organization, and management within the healthcare industry Strategic and operational planning Healthcare economicsPersonnel administrationFederal and state of California healthcare statutes, regulations, and rulesHealthcare industry trendsNegotiating with various pharmacy industry stakeholdersRegional pharmacy communityExcellent writing and communication skills and excellent organizational skillsMust have grit and attention to detailStart your journey towards a thriving future with IEHP and apply TODAY!Work Model LocationThis position is on a hybrid work schedule. (Monday & Friday - remote, Tuesday – Thursday onsite in Rancho Cucamonga, CA.)Pay RangeUSD $246,355.20 - USD $344,905.60 /Yr.Job SummaryCategory: LeadershipPosition Type: Regular Full-TimeWork Model: Hybrid