Director, Pharmacy - Denver Health Medical Plan (* Hybrid Work Schedule *)

Benefits

Additional Information

We are recruiting for a mission-driven Director, Pharmacy - Denver Health Medical Plan (* Hybrid Work Schedule *) to join our team! We're with you for life's journey. At Denver Health, purpose isn't just something we believe in-it's something we live every day, for life's journey. Our Values Respect | Belonging | Accountability | Transparency Department Managed Care Administration * This is a hybrid role located in Denver, Colorado with a requirement of being in the office 3 days per week. Job Summary In accordance with Federal, State and local laws and regulations, the Director of Pharmacy for Denver Health Medical Plan (DHMP) leads the strategic vision and operational execution of pharmacy benefits ensuring alignment with clinical excellence, financial sustainability, and member centric outcomes. This role manages end-to-end pharmacy benefit design, oversight, and performance management across the entire health plan ecosystem from formulary strategy and Pharmacy Benefit Manager (PBM) partnership to member experience and quality improvement. This role bridges clinical rigor with business impact, managing multiple lines of business inclusive of Medicare, Medicaid, CHP+, Exchange and Commercial plans. Working collaboratively with other departments, this role drives optimization of medication access, adherence and cost savings. Using Pharmacogenomics principles and evaluating industry trends, the Senior Director leads a team to review, analyze and monitor pharmacy cost and utilization data to inform and execute on short-term and long-term business goals. Essential Functions : Pharmacy Services Strategies & Oversight: - Provides strategic oversight of all pharmacy functions, including Pharmacy Benefit Manager (PBM) performance, formulary strategy, benefit design, and cost containment. Oversees formulary management and 340B program strategy, including specialty drug utilization, biosimilar uptake, opioid safety, and behavioral health pharmacy integration - Designs and implement pharmacy financial incentive programs, such as prescriber performance bonuses, shared savings models tied to utilization efficiency, outcomes-based rebate innovation, and value-tiered network designs to improve access and affordability - Designs utilization management protocols that enhance formulary compliance through prior authorization oversight of both outpatient and medical pharmacy - Provides oversight of the Pharmacy & Therapeutics (P&T) Committee, ensuring formulary governance, clinical alignment, and rapid adoption/evaluation of emerging therapies - Oversight of diverse Pharmacy Department staff who manage prior authorization review, utilization management protocols, care coordination, Medication Therapy Management (MTM), and medication adherence services - Sets clear expectations for staff by developing job specific customer service expectations and behaviors for each position supervised; clearly communicates expectations to each employee and establishes the expectations as job requirements and performance appraisal components; delegates responsibility/authority whenever possible - Conducts all performance evaluations on time, working with each employee at least annually to set specific behavioral goals. - Defines role-based expectations, facilitates training, promotes retention, and supports staff development - Foster positive employee engagement inclusive of departmental collegiality and organizational belonging. (30%) PBM Partnership and Management: - Negotiate and manage PBM contract with explicit quality and performance targets, ensuring alignment with health plan clinical, regulatory, and cost-saving objectives - Assists in rebate and budget development, processing and monitoring. - Negotiates Service Level Agreements (SLAs) and contract terms in coordination with Legal, Finance, and operational leaders. This includes overseeing any new Request for Proposals (RFP) or contract re-negotiations with the PBM - Monitors vendor performance against defined metrics and escalates gaps for resolution. - Collaborate with quality, care management and member services to integrate pharmacy data into holistic health strategies (25%) Quality and Performance Ownership: - Development and implementation of strategies for the evaluation, performance and enhancement of current and new pharmacy programs including Medication Adherence Programs and Disease Management. - Monitors the managed care pharmacy industry, Health Care Reform and pharmacy benefit design trends to identify new business opportunities and improve the quality and cost effectiveness of the current DHMP Pharmacy program. - Evaluates priorities, performance measures, pharmacy cost metrics and savings opportunities for DHMP using LEAN principles. - Collaborate with Quality Improvement team to support performance on measures including CAHPS, HEDIS, CMS Star Ratings and other value-based metrics related to pharmaceutical use - Set, track and report on pharmacy department oper