Network Director of PBM Services

Job Summary :

The Primary mission is to design and implement pharmacy benefit strategies that balance affordability for the organization with clinical excellence for patients. This involves managing budgets, strategy new to market strategies and ensuring compliance with federal and state regulations

Responsibilities:

Strategic Oversight :

Develop and implement long-term pharmacy benefit strategies that align with organizational goals and mission.

Financial & Budgetary Management :

Manage pharmacy budgets and overseeing Per Member Per Month (PMPM) costs, and optimizing rebate and discount negotiations with manufacturers.

Vendor & Contract Management :

Lead the procurement and ongoing management of PBM contracts, ensuring performance meets defined Service Level Agreements (SLAs).

Clinical & Operational Compliance :

Ensure adherence to evolving state and federal regulations,.

Formulary & Program Design :

Oversee the creation of cost-effective drug formularies, prior authorization programs, and specialty pharmacy initiatives.

Performance Analytics :

Utilize data and AI to monitor key performance indicators (KPIs), such as medication adherence, generic dispensing rates, and member satisfaction scores.

Leadership :

Manage high-performing cross-functional teams, often including clinical pharmacists, account managers, and customer service staff.

Qualifications/Requirements:

Experience:

A minimum of 8 to 10+ years of experience in pharmacy services, healthcare management, or pharmaceutical sales is standard. At least 5 years of direct experience in PBM operations, managed care, or health plan clinical services.

Education:

PharmD required; advanced degree (MS, MHA, MBA, or MPH) preferred.. Licenses /

Certifications:

Current NYS pharmacist license required, or eligible to obtain within 90 days of hire.