Director, Clinical Pharmacy Services - Priority Health
Core
Director overseeing all aspects of Pharmacy Operations and Pharmacy Benefit Administration (PBM) for a large health plan, ensuring compliance, operational efficiency, and vendor performance.
Role type
Director, Clinical Pharmacy Services
Builds
Pharmacy Benefit Administration services, claim adjudication, utilization management, and vendor-managed pharmacy programs.
Domain
Health Insurance / Pharmacy Benefit Management
Required skills
Pharmacy Benefit Administration, PBM performance management, policy and procedure development, budget management, contract management, project management, regulatory compliance (CMS, Medicaid, NCQA, HIPAA), vendor oversight
Technologies
Prior Authorization Software, PBM systems
Responsibilities
Develop policies and processes for compliant Pharmacy Benefit Administration; oversee PBM performance and claim adjudication accuracy; manage Pharmacy Operations budget and vendor contracts; ensure compliance with CMS, Medicaid, NCQA, and HIPAA regulations; lead project plans for operational enhancements.
Seniority
Director, strategic oversight & team leadership
