Director, Pharmacy

Evolent Health   •  

Fort Myers, FL

Industry: Healthcare


5 - 7 years

Posted 92 days ago

This job is no longer available.

What You’ll Be Doing:

Health Plan Pharmacy Leadership

  • Function as the delegated Director of Pharmacy for client health plans including Medicaid and Medicare (including SNP plans)
  • Create and enhance State-specific programs such as lock-in, provider outreach, and quantify the value of those initiatives
  • Collaboratively participate in development & maintenance of the Drug Formulary(s) with Evolent PBM Operations and our key business partners.
  • Oversee (and participate as needed) in client-specific communications process to ensure effective change management.
  • Establish and maintain effective, collaborative working relationships with Evolent PBM Operations, our key business partners, the Market Leadership, and contracted vendors
  • Be the main account management point of contact between the Client and Evolent Health teams
  • Provide pharmacy subject matter expertise during the start-phase (e.g., Ongoing Medicaid operations, interactions with the State as well as Medicare Advantage application & submission process, state-regulatory application process for Commercial health plans) of client health plan operations
  • Ensure management of pharmacy department activity with emphasis on the quality of care, accessibility, financial impact and regulatory compliance.
  • Develop initiatives to identify, track and monitor pharmacy utilization and opportunities for cost savings, trend management, and/or quality improvement.

Pharmacy Services

  • As a member of the pharmacy services leadership, cross collaborate with PBM Operations and Clinical Product Development to build and lead a highly effective, integrated pharmacy services platform
  • Provide joint oversight for pharmacy analytics and modeling assure best in class trend management, clinical outcome achievement, and client service support
  • Contribute to the design, execution and leadership of a comprehensive specialty pharmacy strategy
  • Other duties as assigned.

The Experience You’ll Need (Required):

  • Pharmacy degree; either BS Pharmacy or Pharm. D.
  • 5-10 years of Medicaid experience
  • 3+ years of PBM account management experience
  • Pharmacy benefit & pharmacy health plan operations experience including area such as health plan pharmacy leadership, clinical utilization management, and/or benefit consulting
  • Active Pharmacy License

Finishing Touches (Preferred):

  • Advanced “business” degree (e.g., MBA, MHA)
  • +2 years health plan pharmacy director or PBM clinical operations leadership
  • +2 years Medicare Advantage health plan pharmacy experience
  • “Start-up” experience with Medicare Advantage, Medicaid and/or Commercial plans