[Remote] Director, Pharmacy Clinical Strategy(Preferred Experience In Formulary Strategy & Managed Care)

Note: The job is a remote job and is open to candidates in USA. CareSource is a healthcare management organization that is seeking a Director of Pharmacy Clinical Strategy. The role involves leading the development of formulary management best practices and overseeing the operational management of clinical policy and criteria development teams to ensure efficient drug management across all business lines.ResponsibilitiesEnsures the efficient operational management of the formulary and medical drug management and clinical policy/criteria development teams with emphasis on execution, outcomes, continual improvement and performance enhancementOversees the monitoring of and educates stakeholders on the drug development pipeline and strategies we will employ to appropriately manage new and existing drugsEnsures business partner accountability for the accurate and timely implementation and testing of benefit and formulary changes by our PBM as well as timely and accurate configuration of medical drugsOversees the configuration and testing of pharmacy contracts and medical drugs in the medical claims systemOversees the strategic management of the pharmacy benefit and medical benefitsOversees the management of formulary and medical drug coding changes to minimize member disruption but drive value and better member outcomesParticipates in the negotiation of direct rebates with pharmaceutical manufacturersOversees the development, monitoring and monthly (or more frequent) reporting on key performance indicators (KPIs) related to formulary and medical drug management, including but not limited to cost and member, provider and/or drug utilizationParticipates in the development of Clinical Programs and clinical strategies to drive better member health outcomesEnsures team collaboration with Clinical Program Mangers to create and improve programs that drive better member health outcomesDevelops methods and strategies to identify, quantify and measure total cost of care savings opportunities related to formulary management and medical drug management techniquesReports on the progress of total cost of care initiatives to senior leadershipCollaborates with other stakeholders to create new and creative drug and utilization management strategiesCollaborates with other teams to communicate and educate members, providers, pharmacies, and internal business partners on formulary, prior authorizations, specialty drugs and other initiativesOversees the Pharmacy & Therapeutics and Value Assessment Committees, preparation of meeting materials & presentations, and education of stakeholders following committee meetingsEnsures development of clinical policies and criteria to effectively manage specialty and non-specialty medication utilization in accordance with formulary management best practicesEnsures regulatory and compliance guidelines are met for Medicaid, Medicare, Exchange and future lines of related to formulary and medical drug management and the development of clinical policies and criteriaOversees the development and execution of policies, trainings, and procedures to ensure compliance with new and existing regulations and accreditation standardsAnalyzes data regularly to identify process improvement opportunities relating to formulary and medical drug management, as well as clinical policy and criteria developmentWorks with appeals and grievance team to understand how to better improve formulary management and/or communication to reduce inappropriate or avoidable appeals and grievancesAccountable for motivating, hiring, training, coaching, professional development, succession planning, performance appraisals, and disciplinary actions of staffPerform any other job related duties as requestedSkillsBachelor's degree in Pharmacy requiredThree (3) years of managed care experience requiredTwo (2) years of formulary management experience in Medicare, Marketplace or Medicaid lines of business requiredExperience working with government lines of business (Medicare, Medicare, or Marketplace) in multiple states or markets requiredExperience participating in or leading a P&T Committee requiredPrevious managerial experience requiredUnrestricted registered pharmacist (RPh) Licensure in state of practice requiredIntermediate proficiency in Microsoft Outlook and Microsoft WordAdvanced proficiency in Microsoft PowerPoint and Microsoft Excel (able to create presentation-ready charts & graphs, Pivot tables/charts)Strong problem solving skillsAdvanced presentation skills– ability to interact effectively with internal/external audiences, summarize work for different audiences and create basic charts & graphs from workFamiliarity with medical terminology and medical claims billingExtraordinary attention to detailAbility to synthesize large amounts of findings orally and in writingExcellent time management & leadership skills - effectively, efficiently & accurately managing multiple tasks simultaneously under tight timelines for yourself & your team in a fast-paced healthcare environmentProven track record of creative of “out of the box” thinkingAbility to work independently & within a team environment in a fast-paced healthcare environmentHigh level of curiosity and/or desire to be innovative/creativeAbility to maintain confidentiality and act in the company's best interestStrong oral, written, and interpersonal communication skillsExcellent leadership, management and supervisory skills and experienceEnergetic, enthusiastic, and politically astuteAbility to act with diplomacy and sensitivity to cultural diversityResponsive to a changing environmentStrategic management skillsConflict resolution skillsPlanning, problem identification and resolution skillsStrong decision making skillsCustomer service skills with the ability to interact professionally and effectively with members, providers, internal business areas and colleaguesStrong analytical skills with the ability to create reports and interpret operational, utilization and financial dataProven problem-solving skills with the ability to look for root causes and develop implementable, workable solutionsDoctorate of Pharmacy (Pharm.D.) preferredExperience with state-mandated formularies or drug lists preferredBenefitsBonus tied to company and individual performanceA substantial and comprehensive total rewards packageCompany OverviewCareSource provides managed care services to Medicaid beneficiaries. It was founded in 1989, and is headquartered in Dayton, Ohio, USA, with a workforce of 1001-5000 employees. Its website is https://www.caresource.com/.Company H1B SponsorshipCareSource has a track record of offering H1B sponsorships, with 20 in 2026, 29 in 2025, 39 in 2024, 35 in 2023, 21 in 2022, 37 in 2021, 28 in 2020. Please note that this does not guarantee sponsorship for this specific role.