Director of Medical & Pharmacy Strategy

LOCATION REQUIREMENTS:This position is a hybrid role that will require the associate to be in the office (Dalton GA) at least 2 days a week.

JOB DESCRIPTION:

The Director ofMedical& Pharmacy Strategy will lead Shaws enterprise benefits management plan design and vendor/contract strategy for medical and pharmacy programs covering 27000 enrolled lives. This highly strategic role requires deepexpertiseinbenefitsoperations plan optimization contract negotiation and partnership with brokers/consultants. The ideal candidate will have a proventrack recordin leading large-scale benefits programs managing complex vendor relationships and driving cost and quality improvements through data-driven plan design.

As a strategic thought partner to the Director of Health & Wellness and the Vice President of Total Rewards this individual will develop and execute an integrated medical and pharmacy strategy that prioritizes affordability and health outcomes.This position is ideal for a seasoned strategist who thrives at the intersection of innovation data analysis large-scaleexecution and thoughtful policy design.

POSITION RESPONSIBILITIES:

• Strategic Leadership &BenefitsProgram Design

• Lead the strategy and redesign of Shaws medical and pharmacy benefit programs ensuring alignment with organizationalobjectives financial sustainability and associate well-being.

• Develop and execute enterprise affordability strategies by integrating medical pharmacy and behavioral health data toidentifytrend drivers and implement actionable solutions.

• Serve as the enterprise subject-matter expert for medical and pharmacy plan design contracting and policyadvisingleadership on market trends regulatory changes and innovation opportunities.

• Design and implement evidence-based plan modificationsincluding formulary optimization specialty drug management and clinical policy pathwaysto improve efficiency and reduce spend.

• Provide leadership and oversight to ensure compliance with all federal state and regulatory requirementsofmedical/pharmacy benefit plans.

• Analytics Policy and Cost Management

• Lead contract negotiations renewals and RFPs with medical carriers PBMs and third-party vendors to ensure alignment with enterpriseobjectivesand financial targets.

• Synthesize complex data through claims policy and market analyses to deliver recommendations for plan design costmanagementandutilization.

• Partner with and lead external brokers and consultants to analyze cost andutilizationtrends benchmark plan performance evaluate vendor selection and drive strategic plan redesign.

• Collaborate with data and finance teams to develop self-funded cost projections trend forecasts and contribution modeling.

• Conduct competitor benchmarking and policy analyses to ensure plan competitiveness compliance and market alignment.

• Monitor performance metrics and recommend evidence-based plan and vendor modifications to improve affordability and health outcomes.

• Vendor Strategy & Partnership Optimization

• Lead strategy and governance for Shaws medical carrier and PBM partners ensuring performance excellence transparency and value.

• Evaluate and recommend alternative third-party value-based and carve-out solutions across ambulatory infusion specialty and onsite services to improve access affordability and population health outcomes.

• Integrate medical and pharmacy strategies with Shaws onsite clinics behavioral health and wellness programs to deliver a cohesive Total Rewards experience.

• Develop andmaintainpartnerships with external experts consultants and industry groups to stay ahead of regulatory innovation and policy trends.

REQUIRED QUALIFICATIONS:

• Bachelors degree inBusiness Human ResourcesPharmacy Health Administration Public Health or related field.

• Minimum of 15 years of progressive experience in benefits management health plan operations or pharmacy benefit management withdemonstratedleadership in contracting vendor management and cost optimization.

• Experience leading and managing program contract negotiations.

• Deep knowledge of healthcarepolicy andcompliance (ACA ERISA HIPAA).

• Proven ability to conduct complex data analyses and translate findings into actionable recommendations for leadership.

• Exceptional communication and influencing skills; comfortable presenting to senior executives finance leaders and cross-functional partners.

• Hands-on operator with strong strategic acumenable to balance long-term transformation with immediate execution.

• Demonstrated success managing large-scale projects.

• Limited travelnecessary(likely twoto four times annually).

• High levelof confidentiality.

Preferred Qualifications

• Experience leadingmedical/pharmacy consultants and brokers.

• Strong background in self-funded plan management value-based benefit design and integrated medical and pharmacy analytics.

• Proven experience leading medical plan and pharmacy benefit evaluations transitions and overall program strategy.

COMPETENCIES:

• Establish Strategic Direction

• Drive Entrepreneurial Success

• Drive Execution

• Lead Change

• Build Strategic Partnerships

POTENTIAL FACTORS:

• Propensity to Lead

• Learning Agility

• Adaptability

• Conceptual Thinking

• Navigates Ambiguity