Network Director of PBM Services

Job Summary:

The Primary mission is to design and implement pharmacy benefit strategies that balanceaffordabilityfor the organization withclinical excellencefor patients. This involves managing budgets, strategy new to market strategies and ensuring compliance with federal and state regulations

Responsibilities:

• Strategic Oversight: Develop and implement long-term pharmacy benefit strategies that align with organizational goals and mission.
• Financial Budgetary Management: Manage pharmacy budgets and overseeing Per Member Per Month (PMPM) costs, and optimizing rebate and discount negotiations with manufacturers.
• Vendor Contract Management: Lead the procurement and ongoing management of PBM contracts, ensuring performance meets defined Service Level Agreements (SLAs).
• Clinical Operational Compliance: Ensure adherence to evolving state and federal regulations,.
• Formulary Program Design: Oversee the creation of cost-effective drug formularies, prior authorization programs, and specialty pharmacy initiatives.
• Performance Analytics: Utilize data and AI to monitor key performance indicators (KPIs), such as medication adherence, generic dispensing rates, and member satisfaction scores.
• Leadership: Manage high-performing cross-functional teams, often including clinical pharmacists, account managers, and customer service staff.

Qualifications/Requirements:

Experience:

• A minimum of8 to 10+ yearsof experience in pharmacy services, healthcare management, or pharmaceutical sales is standard.
• At least5 yearsof direct experience in PBM operations, managed care, or health plan clinical services.

Education: PharmD required; advanced degree (MS, MHA, MBA, or MPH) preferred..

Licenses / Certifications: Current NYS pharmacist license required, or eligible to obtain within 90 days of hire.