VP Pharmacy Services

This is a fully remote position, open to applicants in Maine, +1 more state.

📋 Description

• Provides strategic and operational leadership for the Pharmacy division to meet organizational objectives related to financial performance, sustainability, growth, and pharmaceutical management goals.

• Oversees all aspects of pharmacy operations, encompassing formulary management, prior authorizations, formulary exceptions, medication adherence, patient accounting, billing practices, vendor billing oversight, and daily systems operations.

• Ensures the Pharmacy division is prepared for payer, regulatory, contractual, and accreditation requirements, including readiness for the CMS MA bid process.

• Establishes and manages pharmacy performance metrics, data analysis, and quality improvement initiatives.

• Confirms that pharmacy-related policies are clinically sound, adhering to EBM criteria and appropriate utilization management activities, such as step therapy.

• Collaborates with Pharmacy, Finance, Nursing, Medicine, Population Health, Practice, and other divisions to synchronize clinical, administrative, and business processes.

• Provides leadership for pharmacy technology, systems optimization, and workforce planning, which includes technology assessments, software testing and implementation, system enhancements, staffing model development, and recruitment planning.

• Acts as the primary representative and spokesperson for the Pharmacy division, fostering internal and external relationships.

• Offers insights regarding pharmacy market trends, legislative and regulatory developments, and consultant deliverables.

• Manages Medicare Advantage and USFHP pharmacy-related programs, overseeing PBM and pharmacy vendors, Mail Order Pharmacy, contract compliance, rebate optimization, CMS and USFHP compliance, STARS and HEDIS performance, and pharmacy expenditures.

⛳️ Requirements

• BS Pharmacy or PharmD required.

• PharmD, MBA preferred.

• Must hold a pharmacy license in Maine and New Hampshire (or be eligible).

• 10 years of experience, including managed care experience (e.g., PBM, HMO, group practice) and retail pharmacy experience (e.g., chain, independent, mail order).

• Proven experience leading complex, cross-functional projects and implementations.

• Familiarity with pharmacy vendor management, contract oversight, and review of key contractual elements.

• Experience in supporting Medicare bid development, formulary strategy, or pharmacy financial analysis.

• Ability to evaluate pharmacy programs and policies from both clinical and financial perspectives.

• Experience in reviewing financial reports, reconciliations, invoices, and pharmacy trend data.

• Strong understanding of Medicare Part D regulations and the Medicare annual bid process.

• Knowledge of pharmacy benefit design, formulary strategy, PBM operations, and pharmacy claims administration.

• Proficient in pharmacy financial drivers, trend analysis, forecasting inputs, and invoice reconciliation processes.

• Knowledgeable about federal and state laws and regulations, as well as applicable accreditation standards.

• Capable of evaluating pharmacy policies and initiatives through both clinical and financial business judgment.

• Strong grasp of drug pipeline trends and factors influencing pharmacy cost and utilization.

• Excellent oral and written communication skills.

• Exceptional interpersonal skills.

• Strong delegation skills.

• Critical thinking ability.

• Capacity to establish accountability.

• Ability to design work processes centered around customer needs and expectations.

• Strong prioritization skills.

• This position is not eligible for immigration sponsorship.

🏝️ Benefits

• Medical insurance.

• Dental insurance.

• Vision insurance.

• Retirement savings with employer contributions.

• Paid time off.

• Volunteer time off.

• Pie day.

• Other employee benefits.