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

Were with you for lifes journey. At Denver Health purpose isnt just something we believe inits something we live every day for lifes journey.

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Department

* This is a hybrid role with a weekly in-office requirement in Denver Colorado.

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 operational performance goals to meet or exceed Quality metrics and DOI regulatory requirements.
  Compiles data and analysis to for the NCQA accreditation process.
  (30%)
• Organizational Leadership & Governance Engagement:
  Prepares and presents monthly quarterly annual and ad-hoc reports upon request.
  Maintain internal policies and procedures which meet regulatory compliance and industry standards
  Reviews and communicates cost control measures department objectives and effectiveness as well as personnel productivity to promote organizational goals
  Directs special financial operational regulatory case management quality technology and other projects and programs as assigned
  Serves as a voting member of DHMP Compliance QIC Medical Management Network Management and P&T committees
  Maintains bidirectional communication with executive leadership highlighting progress on strategic goals and any challenge areas
  Ensures alignment with Denver Health Medical plan (DHMP) and Denver Health Hospital Authority (DHHA) business priorities. (15%)

Education:

• Doctorate degree Doctor of Pharmacy (PharmD) required

Work Experience:

• Minimum of 5 years administrative Pharmacy Department management experience within a Managed Care Organization PBM Medicaid and/or Medicare Program in a leadership role required
• 1-3 years Director level or higher management experience including: administrative direct supervisory regulatory contract rebate management and program development duties preferred required

Licenses:

• PHA-Licensed Pharmacist - DORA - Department of Regulatory Agencies required

Knowledge Skills and Abilities:

• Analytical Business Development Pharmacoeconomic and Critical thinking skills required.
• Excellent verbal/written communication contract negotiation vendor management presentation training and organizational skills necessary.
• Ability to multi-task develop regulatory guidelines prioritize delegate create and implement standardized processes and operational workflow.
• Industry experience with claims adjudication NCPDP standards Medication Therapy Management (MTM) NCQA HEDIS Pharmacy Benefit design Formulary management Provider Networks Prior Authorization Management Drug Utilization Review Customer Service and application of Commercial Health Medicare Medicaid and CHP programs including regulatory requirements.
• Able to identify the need for new policies and procedures to meet Medicaid Medicare and Department of Insurance (DOI) requirements as well as write and review existing documentation.
• Proven ability to lead cross-functional teams and manage multiple complex projects and provide clearly articulated updates to Executive Leadership.

* This is a hybrid role with a weekly in-office requirement in Denver Colorado.

Shift

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Benefits

At Denver Health we take care of the people who take care of our community. Our benefits are built to support your life your family and your future with generous paid time off fully paid parental leave exceptional retirement contributions comprehensive health coverage and nationally recognized well-being programs. We invest in your growth through tuition assistance career advancement pathways and professional development while also offering meaningful financial advantages through loan forgiveness eligibility and employer contributions. When you join Denver Health youre joining a mission-driven organization that invests in you.

Here is a small list of our benefit programs:

• Paid time off starting at 28 days per year inclusive of vacation personal/sick and 7 Holidays

• 100% paid parental leave up to 6 weeks

• Immediate eligibility for retirement plans with employer contribution up to 9.5%

• Generous medical dental vision plans in addition to employer paid disability and life insurance.

• Comprehensive well-being programs including on-site employee fitness center located on Denver Health main campus and nationally recognized RESTORE Center

• Free RTD EcoPass (public transportation)

• Childcare discount programs & exclusive perks on large brands travel and more

• Tuition reimbursement & assistance

• Education coaching and professional development opportunities through the Workforce Development Center (WFDC) that support internal career growth and advancement pathways

• Professional clinical advancement program & shared governance

• Public Service Loan Forgiveness (PSLF) eligible employer free student loan coaching and assistance navigating the PSLF program

• National Health Service Corps (NHCS) and Colorado Health Service Corps (CHSC) eligible employer

About Denver Health

Denver Health is an integrated high-quality academic health care system considered a model for the nation that includes a Level I Trauma Center a 555-bed acute care medical center Denvers 911 emergency medical response system 10 family health centers 19 school-based health centers Rocky Mountain Poison & Drug Safety the Public Health Institute at Denver Health Denver Health Medical Plan and Denver Health Foundation.

As Colorados primary and essential safety-net health care system Denver Health is a mission-driven organization that has provided millions in uncompensated care for the uninsured each year.

Located near downtown Denver Denver Health is just minutes away from many of the cultural and recreational activities Denver has to offer.

Denver Health is an equal opportunity employer (EOE). We value the unique ideas talents and contributions reflective of the needs of our community. All job applicants for safety-sensitive positions must pass a pre-employment drug test once a conditional offer of employment has been made. Applicants will be considered until the position is filled.