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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates extensive experience in leading pharmacy operations, strategic planning, and compliance with healthcare regulations, while effectively managing pharmacy benefit programs and improving clinical outcomes. Possesses strong leadership skills to empower teams and drive innovative cost containment and quality assurance initiatives.
Highest-signal resume keywords
Pharmacy Benefit Management (PBM) OversightRegulatory Compliance (CMS, DHCS, DMHC)Clinical Program Implementation (CMS Star Rating, NCQA)Strategic Direction and Operational EfficiencyBudget Management
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Pharmacy Operations ManagementData Analytics for Care ImprovementContract NegotiationQuality Assurance Program ImplementationMedication Adherence StrategiesCost Containment PoliciesFormulary ManagementPerformance Metrics MonitoringClinical Knowledge in Pharmacy ProgramsTrend Identification in Treatment Patterns
Soft Skills
Excellent Communication SkillsOrganizational SkillsLeadership and Team ManagementAttention to DetailGrit
Certifications & Qualifications
Pharm. D. from an Accredited InstitutionRegistered Pharmacist License (California)
Industry Keywords
Healthcare EconomicsMedi-CalMedicareExchangeNCQA Pharmacy RegulationsFederal and State Healthcare StatutesPharmacy Industry StakeholdersClinical Care ModelsValue-Based InitiativesPharmacy Quality Performance
About the role
Key responsibilities & impact- Develop and execute enterprise pharmacy strategies across Medi-Cal, Medicare, and Exchange
- Collaborate with executive leadership to integrate pharmacy strategies into clinical care models, value-based initiatives, operations, quality, and clinical programs
- Lead initiatives to improve medication adherence, clinical outcomes, cost efficiency, and pharmacy quality performance
- Ensure compliance with CMS, DHCS, DMHC, and federal/state regulatory requirements
- Oversee pharmacy policy development and alignment with regulations and industry best practices
- Serve as the organization’s pharmacy compliance lead, ensuring audit readiness and regulatory deliverables
- Manage PBM and vendor relationships, including contract negotiation and performance programs
- Monitor formulary, rebate, and utilization management programs
- Ensure PBM performance metrics align with pricing strategy, member satisfaction, and health outcomes
- Direct pharmacy operations and clinical programs, including MTM, prior authorization, grievances and appeals, and performance measures
- Use data analytics to identify trends, cost drivers, and care improvement opportunities
- Drive access and affordability initiatives for vulnerable populations
- Establish and monitor productivity metrics
- Ensure adherence to departmental and organizational policies, procedures, and standards
- Partner with Quality, Provider Services, Case Management, Finance, and Actuarial on innovation and integrated care delivery
- Represent the pharmacy department in leadership forums, regulatory meetings, and industry engagements
- Hire, train, and manage support staff; monitor and evaluate outcomes
- Conduct performance reviews in accordance with IEHP guidelines
- Perform other duties required to support health plan operations and department needs
Requirements
What you’ll need- At least ten (10) years of experience leading the strategic direction, operational efficiency, and financial performance of a pharmacy department
- Senior level management, policy development and decision-making, with development and implementation of management best practices
- Senior level management of a pharmacy benefit program spanning Medicare, Medi-Cal and Exchange
- Pharmacy Benefit Management (PBM) oversight (CMS and Commercial)
- Clinical knowledge in implementing quality and clinical pharmaceutical programs (CMS star rating programs, DHCS MCAS measure improvement, NCQA quality programs)
- Experience leading and directing a team of clinical and operational pharmacists, pharmaceutical technicians, analysts, and special program managers
- Annual budget management
- Experience identifying trends or changes in treatment patterns and developing/implementing program changes
- Experience implementing innovative cost containment policies and procedures
- Experience implementing quality assurance programs
- Experience empowering staff through education and appropriate work
- Pharm. D. from an accredited institution required
- Possession of an active, unrestricted, and unencumbered Registered Pharmacist license issued by the California State Board of Pharmacy required
- MBA from an accredited institution preferred
- Comprehensive knowledge of CMS, DHCS, DMHC and NCQA pharmacy regulations
- Knowledge of business principles and techniques of administration, organization, and management within the healthcare industry
- Knowledge of strategic and operational planning
- Knowledge of healthcare economics
- Knowledge of personnel administration
- Knowledge of federal and state of California healthcare statutes, regulations, and rules
- Knowledge of healthcare industry trends
- Experience negotiating with various pharmacy industry stakeholders
- Knowledge of the regional pharmacy community
- Excellent writing, communication, and organizational skills
- Grit and attention to detail
Benefits
Comp & perks- Competitive salary
- Hybrid schedule
- State of the art fitness center on-site
- Medical Insurance with Dental and Vision
- Life, short-term, and long-term disability options
- Career advancement opportunities and professional development
- Wellness programs that promote a healthy work-life balance
- Flexible Spending Account – Health Care/Childcare
- CalPERS retirement
- 457(b) option with a contribution match
- Paid life insurance for employees
- Pet care insurance