Director, Pharmacy - Denver Health Medical Plan (* Hybrid Work Schedule *)
Core
Leads strategic vision and operational execution of pharmacy benefits for a health plan, ensuring alignment with clinical excellence, financial sustainability, and member-centric outcomes.
Role type
Director of Pharmacy (Managed Care)
Builds
Pharmacy benefit design, PBM partnerships, and member experience programs for Medicare, Medicaid, CHP+, Exchange, and Commercial plans.
Domain
Healthcare / Managed Care / Pharmacy Benefit Management
Deliverable
production ML models | product features | dashboards & analysis | research | client delivery | infrastructure | physical/clinical work
Required skills
Formulary strategy, PBM contract negotiation, utilization management, regulatory compliance (Medicare/Medicaid/DOI), team leadership, financial incentive design, quality metrics analysis
Preferred skills
Pharmacogenomics principles, LEAN principles, NCQA accreditation, HEDIS/CMS Star Ratings expertise
Technologies
NCPDP standards, claims adjudication systems, prior authorization platforms
Responsibilities
Oversee formulary management and 340B program strategy; negotiate PBM contracts and SLAs; design utilization management protocols; lead the Pharmacy & Therapeutics (P&T) Committee; manage department staff performance and development; report on operational performance and cost metrics.
Seniority
Director level, strategic leadership with direct supervisory duties