As the Director, Clinical Affairs, Pharmacy you are a leader responsible for pharmacy-related health plan
pharmacy benefit clinical including PBM oversight, formulary strategy and development, prior authorization,
drug utilization review and clinical health plan programs. This role will work collaboratively with other health
plan functions such as medical management, care management, utilization management, population health,
compliance, and quality to ensure coordination and alignment of the pharmacy benefit with the needs of the
patient and organization.

ESSENTIAL DUTIES AND RESPONSIBILITIES
● Provide oversight of the day-to-day operations of the Pharmacy Benefit Manager (PBM) to ensure the
pharmacy benefits, formulary and network are accurately configured.
● Ensure regulatory compliance of all functions delegated to the PBM including, not limited to formulary
design, network access, transition policies and communication materials. Support PBM oversight
including PBM audits.
● Provide support for the Financial Advisory Committee including drug cost information and trends.
Oversee OIG and health plan compliance for the pharmacy benefit.
● Oversee and develop clinical pharmacy programs.
● Develop and update clinical criteria and plan coverage to support the health plan pharmacy and medical
affairs.
● Work cross functionally with medical management, medical directors, care management, quality, etc.
● Utilize pharmacoeconomic analysis to design a formulary that optimizes competing treatment options
based on costs and patient outcomes.
● Work cross-functionally to develop strategies that coordinate the pharmacy and medical benefit.
● Assist in the development and rollout of pharmacy-related initiatives.
● Develops policies and procedures (P&Ps) and standard operating procedures (SOPs) to support the
department.
● Ensure plan website pharmacy information is accurate and up to date.
● Support sales and business development through RFP responses to grow the business.
● Support Curative Pharmacy as needed to ensure alignment of the plan and pharmacies.
● Key member of internal and external committees including program development, reporting, and
leadership committees. Member of Pharmacy leadership team and interdisciplinary teams to lead clinical
pharmacy strategy.

●Develop clinical pharmacy communications including changes in benefit, provider education, newsletter,
and program implementations for the MCO.
● Support various departments within the plan and serve as the point of contact for escalated clinical
pharmacy issues.
● Provide pharmacy benefit consultation and reporting for PBM compliance, trend, formulary, and care.
● Perform cost savings analyses and economic modeling.
● Oversee management of different verticals in the organization (i.e. Formulary Management Team, PA
Team etc.)
● Work adhering to US regulatory and Quality System requirements (21 CFR 820, etc.).
● Supports the residency program for PGY-1 residents
● This position assumes and performs other duties as assigned.

● The majority of work responsibilities are performed remotely or in an office setting, carrying out
detailed work sitting at a desk/table and working on the computer. Travel will be required

QUALIFICATIONS
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The
requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable
accommodations may be made to enable individuals with disabilities to perform the essential functions:

● 7-10+ years of progressively responsible Managed Care experience, PBM or Health plan experience
● 2+ years of management experience required.
● Strong managed care experience with of formulary design and maintenance, PA team management and
PBM oversight
● Managed Care Health Plan and/or PBM clinical pharmacy experience
● Strong comprehension and clinical knowledge of pharmaceutical therapies
● Strong technical skills with MS office running pivot tables or data analysis
● Quantitative skills for statistical analysis and assessment

EDUCATION and/or EXPERIENCE
●Must have a Doctorate in Pharmacy (PharmD) or Bachelor of Science in Pharmacy (BSPharm)

●Must be a Registered Pharmacist (RPh) in the state of Texas or able to obtain a Texas license within 60
days of employment.

CERTIFICATES, LICENSES, REGISTRATIONS
●Registered Pharmacist (RPh)

WORK ENVIRONMENT
The work environment characteristics described here are representative of those an employee encounters while
performing the essential functions of this job. Reasonable accommodations may be made to enable individuals
with disabilities to perform the essential functions.

● For this position the percentage of expected Travel is: 10-20% of the time.