MedStar Southern Maryland Hospital Center

Pharmacy Director - Health Plan

MedStar Southern Maryland Hospital Center • $161K — $348K *
Columbia, MD 21044In-Person
Healthcare
8 - 10 years of experience
Today
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Job Overview by Ladders

Qualifications

  • Doctor of Pharmacy (PharmD) from an accredited College of Pharmacy required
  • 8-10 years of pharmacy leadership experience in health plans or PBM operations required
  • Experience in Medicare Part D, Medicaid, or commercial pharmacy benefits preferred
  • Licensure as a pharmacist in D.C. or eligibility for reciprocity required
  • Preferred board certifications include BCPA, BCPS, BCACP, and PTCB.

Responsibilities

  • Develop and implement pharmacy strategies aligned with organizational health goals
  • Lead formulary management and medication utilization management programs
  • Oversee pharmacy benefit design and cost containment initiatives
  • Manage relationships with pharmacy benefit managers (PBMs) and specialty vendors
  • Monitor performance metrics and implement improvement initiatives
  • Direct clinical programs like prior authorization and medication therapy management (MTM)
  • Collaborate with healthcare teams to optimize medication use

Benefits

  • Strong focus on population health and value-based care
  • Opportunity to lead innovative pharmacy strategies
  • Engagement with clinical leadership and health plan operations
  • Professional development through mentoring clinical staff
  • Support for compliance with national guidelines and regulations
Full Job Description
General Summary of Position
The Director of Pharmacy provides strategic leadership and operational oversight for pharmacy benefit management formulary strategy medication utilization and pharmacy quality initiatives across the health plan. This role is responsible for ensuring safe cost effective and evidence-based medication use while supporting regulatory compliance value-based care initiatives and population health goals. The Director collaborates with clinical leadership pharmacy benefit managers (PBMs) providers and health plan operations to optimize pharmacy programs that improve patient outcomes and manage total cost of care.
Primary Duties and Responsibilities

  • Develop and implement the health plan pharmacy strategy aligned with organizational goals and population health priorities.
  • Lead formulary management pharmacy policy development and medication utilization management programs.
  • Provide oversight of pharmacy benefit design and cost containment initiatives.
  • Manage relationships with pharmacy benefit managers (PBMs) and specialty pharmacy vendors.
  • Oversee formulary development rebate programs contract performance and pharmacy network management.
  • Monitor pharmacy benefit performance metrics and implement improvement initiatives.
  • Direct programs such as: Prior authorization step therapy medication therapy management (MTM) specialty pharmacy management
  • Ensure clinical programs are evidence based and aligned with national guidelines and regulatory requirements.
  • Ensure compliance with CMS NCQA state regulations and accreditation standards related to pharmacy services.
  • Support Medicaid pharmacy program requirements as applicable.
  • Lead pharmacy-related quality initiatives and performance reporting.
  • Use pharmacy claims and clinical data to: Identify utilization trends manage drug spend support value-based care models.
  • Develop dashboards and reporting to monitor pharmacy performance indicators.
  • Collaborate with physicians pharmacists and care management teams to optimize medication use.
  • Serve as a subject matter expert on pharmacy policy and medication management.
  • Support provider education on formulary updates and pharmacy programs.
  • Recruit develop and supervise pharmacy and clinical staff.
  • Foster a culture of collaboration accountability and continuous improvement.
    • Minimal Qualifications
    Education
    • Bachelor's degree Graduate training in an accredited College of Pharmacy. required
    • Doctoral degree Doctor of Pharmacy (PharmD) required
    • Advanced degree (MBA MPH MHA) preferred
    Experience
    • 8-10 years Pharmacy leadership experience required
    • Significant experience in health plan pharmacy PBM operations or managed care pharmacy required
    • Experience with Medicare Part D Medicaid or commercial pharmacy benefitspreferred Certifications required
    Licenses and Certifications
    • PharmD - licensed pharmacist in the District of Columbia or eligibility for reciprocity upon hire (required) Upon Hire required
    • BCPA-Board Certified Patient Advocate Board Certification (e.g. BCPS BCACP) preferred
    • PTCB - Pharmacy Technician Certification Board Board Certification (e.g. BCPS BCACP) preferred
    • PHARMACOTH - Board Certified Pharmacotherapy Specialist Board Certification (e.g. BCPS BCACP) preferred
    Knowledge Skills and Abilities
    • Managed care pharmacy expertise
    • Pharmacy benefit design and formulary management
    • Regulatory and accreditation knowledge (CMS NCQA)
    • Financial and utilization analytics
    • Strategic leadership and change management
    • Stakeholder collaboration and communication
    • Pharmacy cost trend and total drug spend
    • Medication adherence and quality metrics
    • Formulary compliance and utilization management outcomes
    • PBM contract performance
    • Regulatory and accreditation compliance

    This position has a hiring range of

    USD $161,158.00 - USD $348,296.00 /Yr.

    About MedStar Southern Maryland Hospital Center

    MedStar Southern Maryland Hospital Center is a medical facility located in Clinton, Maryland. It is a 192-bed acute care hospital that provides a range of services including emergency care, cardiology, cancer care, orthopedics, and women's health. The hospital is part of the MedStar Health system, which is the largest healthcare provider in Maryland and the Washington, D.C. region. MedStar Southern Maryland Hospital Center is committed to providing high-quality, compassionate care to its patients and improving the health of the communities it serves.
    Learn more about MedStar Southern Maryland Hospital Center
    Size
    1,200 employees
    Industry
    Healthcare
    * Ladders Estimates

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