Director, Specialty Clinical Solutions

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

📋 Description

• Supervise clinical services and strategies within Medical Pharmacy and Specialty programs.

• Act as the primary clinical consultant and subject matter expert for designated clients.

• Offer strategic advice on medical pharmacy and specialty programs.

• Collaborate with account management and business development teams to enhance client retention, identify growth opportunities, conduct financial analyses, and initiate new business ventures.

• Create innovative strategies for medical pharmacy utilizing data-driven insights, clinical solution design, and program improvements.

• Assess emerging therapies, market trends, and opportunities for medical benefit drug management.

• Manage client-facing medical pharmacy programs and utilization management solutions, including fee schedule management, prior authorization, and post-service claim adjustments.

• Discover opportunities to enhance existing programs and propose new solutions.

• Work alongside cross-functional teams to assess program performance, establish business rules, provide actionable insights, and promote continuous improvement.

• Lead the creation of client-facing clinical materials, strategic presentations, thought leadership content, and industry publications.

• Represent the organization as a clinical expert and mentor through industry participation, enterprise initiatives, conference presentations, and guidance to peers and cross-functional partners.

• Carry out additional duties as assigned.

⛳️ Requirements

• Doctor of Pharmacy (PharmD) or Bachelor of Science in Pharmacy degree.

• Minimum of 7 years of experience in medical pharmacy or within a health plan across multiple lines of business.

• Active pharmacist license to practice in the relevant state(s).

• Must be authorized to work in the United States without requiring a work visa or residency sponsorship.

• Strong interpersonal, communication, consultation, organizational, tracking, and follow-up abilities.

• Capability to research, gather, coordinate, and integrate feedback from various operational groups.

• Exceptional verbal and written communication skills.

• Strong presentation capabilities.

• Preferred: Experience in medical pharmacy management, strategy development, and data interpretation within a health plan.

• Preferred: Experience in managing drugs on both the Pharmacy and Medical benefit across all lines of business within a health plan.

• Ability to adhere to security responsibilities and comply with legal, regulatory, contractual, and internal policy requirements.

• Ability to perform the essential functions of the position, with reasonable accommodations where applicable.

🏝️ Benefits

• Benefits, incentives, and additional compensation are available through the employer’s Benefits Page.

• Reasonable accommodations provided for employees with disabilities.

• Equal opportunity and affirmative action employment.

• Tobacco-Free Workplace.