Job Description

Your Role

The Pharmacy Operations team provides management and end-to-end oversight of Pharmacy operations, incident management, and driving resolution from identification to resolution within a matrixed environment. The Director, Pharmacy Operations will report to the Senior Vice President / Chief Pharmacy Officer. In this role you will lead a team who are responsible for providing excellent pharmacy operations services, resolving pharmacy-related incidents, providing pharmacy expertise for members and clients, developing business requirements for incident resolution and project implementation, providing vendor oversight over operations and leading annual pharmacy benefit implementations.

Responsibilities

Your Work
In this role, you will:

• Lead a team to track and drive accurate, timely and exceptional pharmacy benefit operations for all lines of businesses. The scope includes but not limited to pharmacy benefit claims processing, integrated accumulators, pharmacy networks, annual pharmacy benefit implementation and business requirements development and maintenance
• Monitor ongoing performance and drive solutioning and timely resolution of issues that may involve multiple vendors, including information technology (IT), claims processing, retail, home delivery, and specialty pharmacies
• Provide accurate and timely pharmacy benefit research and consultative services to support escalated pharmacy-related questions from members and employer group clients
• Develop end-to-end performance metrics and measurements to monitor, report, and explain pharmacy operations performance to internal stakeholders
• Lead, drive and/or negotiate with vendors and teams where necessary to facilitate development of timely and thorough work plan to resolve operational issues, support benefit implementation, and adherence to contract requirements and expectations
• Mentor a team of managers, supervisors, and individual contributors and build a high performing workplace to do meaningful work

Qualifications

Your Knowledge and Experience

• Requires a college degree or equivalent experience
• Requires 10 years of health plan and/or pharmacy benefit manager (PBM) operations experience
• Requires 6 years of experience managing teams in pharmacy claims processing, pharmacy benefit implementation, and vendor management
• Requires excellent written and verbal communication skills. Experience and skills in presenting complex operational subjects to executive and non-technical audiences is preferred
• Experience with leading and driving cross functional team consensus and discussions, including internal business partners and external vendors is preferred

Hybrid

This role requires employees to be in-office based on our hybrid workplace model, balancing purposeful in-person collaboration with flexibility. For most teams, this means coming into the office two days each week.

Employees living more than 50 miles from an office location will work with their manager to determine in-office time based on business need.

About the Team

Physical Requirements:

Office Environment - roles involving part to full time schedule in Office Environment. Based in our physical offices and work from home office/deskwork - Activity level: Sedentary, frequency most of work day.

Please click here for further physical requirement detail.