Vice President – Pharmacy Position Available In Fulton, Georgia

Job Description:

Summary The Vice President, Pharmacy is a senior executiveleader responsible for setting and executing G.E.H.A’s enterprisepharmacy strategy. In partnership with the Chief Medical Officer,this role oversees all aspects of pharmacy operations, benefitmanagement, PBM oversight, pharmacy network strategies, clinicalpharmacy programs, and regulatory compliance. Serving as a keymember of the clinical executive team, this role is critical tomanaging pharmacy utilization trends, optimizing the Medical LossRatio (MLR), and ensuring integration of pharmacy strategy acrosspopulation health, utilization management, and quality initiativesfor all G.E.H.A products and lines of business. The ideal candidateis a PharmD with deep PBM and managed care experience, strongfinancial and regulatory acumen, and a proven record of drivinginnovation, compliance, and outcomes in a payer environment. Duties

• Define and lead G.E.H.A’s pharmacy enterprise strategy inalignment with corporate goals, clinical outcomes, and costcontainment initiatives.
• Lead oversight of PBM vendor(s),including contracting, network design, rebate strategy, pricingoversight, and service performance.
• Guide formulary management,drug pipeline forecasting, and cost control initiatives across allproducts and lines of business.
• Oversee development andimplementation of clinical pharmacy programs including priorauthorization, adherence support, and medication therapymanagement.
• Ensure full compliance with OPM, CMS, NCQA, URAC, andother applicable state/federal regulations governing pharmacybenefit management.
• Partner with Medical, Care Management,Behavioral Health, and Clinical Quality to drive integration ofpharmacy-related strategic initiatives into population healthefforts.
• Collaborate with Product, Legal, Compliance, andGovernment Affairs teams to ensure pharmacy benefits are designedand administered to meet member and employer needs.
• Serve as thepharmacy subject matter expert on MLR strategy, risk mitigation,and value-based contract modeling.
• Provide executive leadershipto a cross-functional team including pharmacists, analysts, andoperational professionals.
• Foster a high-performance culturefocused on innovation, data-driven decision making, and strategicexecution.
• Represent G.E.H.A in external forums, vendornegotiations, and policy advocacy efforts related to pharmacytrends and affordability. Knowledge, Skills, and Abilities
• Deepunderstanding of pharmacy benefit management structures, specialtydrug pipelines, formulary design, and utilization management
• Strategic and operational leadership in a managed care orintegrated health plan environment
• Strong financial acumen,including ability to influence pharmacy trends, manage rebates, andsupport actuarial forecasting.
• Excellent vendor management andnegotiation skills
• Strong knowledge of federal and state pharmacyregulations, CMS Part D, EGWP, and FEHB requirements
• Demonstratedsuccess in cross-functional collaboration and enterprise strategydevelopment.
• Excellent verbal and written communication skills toeffectively interact with stakeholders and convey complexinformation in a clear manner.
• The ability to lead throughcomplexity and drive changes in a dynamic healthcare environment.
• Strong analytical, critical thinking, and decision-makingcapabilities. Leadership and Team Management
• Provide visionaryleadership to the Pharmacy team, setting clear objectives,priorities, and performance expectations.
• Foster a collaborativeand high-performance work environment where team members aremotivated, engaged, and empowered to contribute their best.
• Mentor and coach team members, supporting their professional growthand skill development in pharmacy design, development, andmanagement. Regulatory Compliance and Quality Assurance
• Workclosely with legal and compliance teams to ensure that Pharmacyadheres to all relevant regulatory and compliance standards.
• Implement rigorous quality assurance processes to ensure thatPharmacy meets the highest standards of safety, security, andreliability.