OverviewReporting 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 options
- Career advancement opportunities and professional development.
- Wellness programs that promote a healthy work-life balance.
- Flexible Spending Account - Health Care/Childcare
- CalPERS retirement
- 457(b) option with a contribution match
- Paid life insurance for employees
- Pet care insurance
Key Responsibilities- Develop 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 programs
- Lead initiatives to improve medication adherence, clinical outcomes, cost efficiency, and overall pharmacy quality performance
- Ensure compliance with CMS, DHCS, DMHC and all federal/state regulatory requirements governing pharmacy benefits
- Oversee pharmacy policy development, ensuring alignment with evolving regulations and industry best practices
- Serve as the organization's pharmacy compliance lead, ensuring audit readiness and fulfillment of regulatory deliverables
- Manage PBM and vendor relationships, including contract negotiation, performance programs to maximize clinical and financial value
- Monitor formulary, rebate, and utilization management programs to maximize clinical and financial value
- Ensure PBM performance metrics align with pricing strategy, member satisfaction, and health outcomes
- Direct pharmacy operations and clinical programs, including MTM, prior authorization, grievance and appeals, and performance measures
- Leverage data analytics to identify trends, cost drivers, and care improvement opportunities
- Drive access and affordability initiatives, particularly for vulnerable populations
- Establish and monitor productivity metrics to support operational excellence and staff performance
- Ensure adherence to departmental and organizational policies, procedures, and standards
- Partner cross-functionally with Quality, Provider Services, Case Management, Finance, and Actuarial to support innovation and integrated care delivery
- Represent the pharmacy department in cross-functional leadership forums, regulatory meetings, and industry engagements
- Hire, train, and manage support staff, while monitoring and evaluating outcomes. Conduct performance reviews of each Team Member within IEHP guidelines
- Perform any other duties as required to ensure Health Plan operations and department business needs are successful
QualificationsEducation & 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 initiatives
- Senior level management, policy development and decision-making, with development and implementation of management best practices
- Senior level management of a pharmacy benefit program spanning Medicare, Medi-Cal and Exchange
- Pharmacy 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 managers
- Annual budget management
- Past successes in:
- Identifying trends or changes in treatment patterns and developing / implementing program changes to accommodate treatment changes
- Implementing innovative cost containment policies and procedures
- Implementing quality assurance programs
- Empowering staff to succeed through education and appropriate work
- Pharm. D. from an accredited institution required
- MBA from an accredited institution preferred
- Possession of an active, unrestricted, and unencumbered Registered Pharmacist license issued by the California State Board of Pharmacy required
Key Qualifications- Comprehensive knowledge of:
- CMS, DHCS, DMHC and NCQA pharmacy regulations
- Business principles and techniques of administration, organization, and management within the healthcare industry
- Strategic and operational planning
- Healthcare economics
- Personnel administration
- Federal and state of California healthcare statutes, regulations, and rules
- Healthcare industry trends
- Negotiating with various pharmacy industry stakeholders
- Regional pharmacy community
- Excellent writing and communication skills and excellent organizational skills
- Must have grit and attention to detail
Start 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.
