Director, Pharmacy Operations Strategy – Integration

This is a fully remote position, open to applicants in Texas.

📋 Description

• Establish the strategy for operational excellence within the pharmacy, including the operating rhythm and execution model.

• Spearhead key transformation initiatives within pharmacy operations from strategy formulation to execution, which encompasses opportunity identification, roadmap creation, operational preparedness, launch planning, and ongoing adoption.

• Act as a primary operational collaborator among internal and external teams, translating pharmacy and PBM opportunities, as well as member and provider requirements, into priorities, decisions, and measurable outcomes.

• Analyze relevant PBM, pharmacy benefits, managed care, and healthcare regulatory standards.

• Maintain a comprehensive understanding of the pharmacy and healthcare landscape, including payer economics, benefit and network dynamics, claims processes, formulary management, prior authorization workflows, utilization trends, vendor transitions, affordability, and experience drivers.

• Collaborate with internal stakeholders and external vendors to develop implementation strategies, conduct business reviews, facilitate strategic meetings, escalate issues, monitor performance, and integrate operations.

• Coordinate activities across Clinical, Pharmacy Operations, Product, Engineering, Finance, Actuarial, Concierge, Compliance, and vendor partners.

• Identify process, data, technology, and vendor friction points, and create comprehensive solutions.

• Enhance member and provider experiences throughout pharmacy journeys.

• Oversee governance and executive reporting for initiatives aimed at achieving operational excellence in pharmacy.

• Recognize and manage risks associated with implementation, dependencies, decisions, and change-management requirements.

• Develop operating playbooks, process standards, controls, and best practices for a scalable PBM operational framework.

• Resolve complex issues and determine suitable actions for technology-driven process enhancements and operational transformations.

• Assist in capacity planning, budget oversight, business-case development, and value realization assessment.

• Ensure that workflows, vendor capabilities, and program execution align with regulatory, compliance, quality, and contractual standards.

• Adhere to relevant laws and regulations.

• Carry out additional responsibilities as assigned.

⛳️ Requirements

• A minimum of 10 years of experience in healthcare, business operations, strategy and operations, product operations, or program leadership.

• At least 7 years of experience in Managed Care, PBM, pharmacy operations, clinical operations, or related healthcare payer roles.

• Over 5 years of experience leading large-scale, cross-functional strategy, operational transformation, or implementation projects from opportunity identification to launch and adoption.

• More than 5 years of experience collaborating directly with cross-functional business, Product, Engineering, vendor, or operations teams to prioritize tasks, define requirements, influence solutions, and achieve business outcomes.

• Proficient in interpreting regulatory, compliance, operational, or contractual business needs and converting them into actionable requirements.

• Experience in strategic planning, roadmapping, business analysis, operational readiness, change management, and executing cross-functional plans.

• Skilled in converting complex operational data and performance metrics into executive-level insights, recommendations, and governance documents.

• Experience managing budgets, capacity models, business cases, or financial outcomes for operational or transformation projects.

• An MBA, MPH, or a Master's degree in Business Administration or a related field is preferred.

• Familiarity with management consulting, internal strategy and operations, process engineering, Lean methodologies, or Six Sigma.

• Experience with PBM implementation, pharmacy benefit administration, claims adjudication, formulary management, prior authorization, rebate/formulary systems, or healthcare data feeds.

• Experienced in working within matrixed teams during enterprise transformations, implementations, or operational excellence initiatives.

🏝️ Benefits

• Employee benefits.

• Unlimited vacation policy.

• Company equity grants.

• Annual performance bonuses.

• Medical coverage.

• Dental coverage.

• Vision coverage.

• 11 paid holidays.

• Paid sick leave.

• Paid parental leave.

• Participation in a 401(k) plan.

• Life insurance.

• Disability insurance.

• Paid wellness time.

• Wellness reimbursements.