Director, Pharmacy - Denver Health Medical Plan (* Hybrid Work Schedule *)
Job Summary
In accordance with Federal, State and local laws and regulations, the Director of Pharmacy for Denver Health Medical Plan (DHMP) leads the strategic vision and operational execution of pharmacy benefits ensuring alignment with clinical excellence, financial sustainability, and member centric outcomes. This role manages end-to-end pharmacy benefit design, oversight, and performance management across the entire health plan ecosystem from formulary strategy and Pharmacy Benefit Manager (PBM) partnership to member experience and quality improvement.
Essential Functions
Pharmacy Services Strategies & Oversight: Provides strategic oversight of all pharmacy functions, including Pharmacy Benefit Manager (PBM) performance, formulary strategy, benefit design, and cost containment. Oversees formulary management and 340B program strategy, including specialty drug utilization, biosimilar uptake, opioid safety, and behavioral health pharmacy integration.
Designs and implement pharmacy financial incentive programs, such as prescriber performance bonuses, shared savings models tied to utilization efficiency, outcomes-based rebate innovation, and value-tiered network designs to improve access and affordability.
Oversees utilization management protocols that enhance formulary compliance through prior authorization oversight of both outpatient and medical pharmacy.
Oversees the Pharmacy & Therapeutics (P&T) Committee, ensuring formulary governance, clinical alignment, and rapid adoption/evaluation of emerging therapies.
Sets clear expectations for staff by developing job specific customer service expectations and behaviors for each position supervised; clearly communicates expectations to each employee and establishes the expectations as job requirements and performance appraisal components; delegates responsibility/authority whenever possible.
Foster positive employee engagement inclusive of departmental collegiality and organizational belonging.
PBM Partnership and Management
Negotiate and manage PBM contract with explicit quality and performance targets, ensuring alignment with health plan clinical, regulatory, and cost-saving objectives.
Aids in rebate and budget development, processing and monitoring. Negotiates Service Level Agreements (SLAs) and contract terms in coordination with Legal, Finance, and operational leaders. This includes overseeing any new Request for Proposals (RFP) or contract re-negotiations with the PBM.
Maintains vendor performance against defined metrics and escalates gaps for resolution.
Collaborates with quality, care management and member services to integrate pharmacy data into holistic health strategies.
Quality and Performance Ownership
Develops and implements strategies for the evaluation, performance and enhancement of current and new pharmacy programs including Medication Adherence Programs and Disease Management.
Evaluates priorities, performance measures, pharmacy cost metrics and savings opportunities for DHMP using LEAN principles.
Collaborates with Quality Improvement team to support performance on measures including CAHPS, HEDIS, CMS Star Ratings and other value-based metrics related to pharmaceutical use.
Compiles data and analysis to for the NCQA accreditation process.
Organizational Leadership & Governance Engagement
Prepares and presents monthly, quarterly, annual and ad-hoc reports upon request.
Maintains internal policies and procedures which meet regulatory compliance and industry standards.
Reviews and communicates cost control measures, department objectives and effectiveness, as well as personnel productivity to promote organizational goals.
Serves as a voting member of DHMP Compliance, QIC, Medical Management, Network Management, and P&T committees.
Maintains bidirectional communication with executive leadership highlighting progress on strategic goals and any challenge areas.
Ensures alignment with Denver Health Medical plan (DHMP) and Denver Health Hospital Authority (DHHA) business priorities.
Education, Work Experience, Licenses, Knowledge, Skills And Abilities
Doctorate degree Doctor of Pharmacy (PharmD) required.
Minimum of 5 years administrative Pharmacy Department management experience within a Managed Care Organization, PBM, Medicaid, and/or Medicare Program in a leadership role required.
1-3 years Director level or higher management experience including: administrative, direct supervisory, regulatory, contract, rebate management and program development duties preferred.
PHA-Licensed Pharmacist - DORA - Department of Regulatory Agencies required.
Shift
Days (United States of America)
Work Type
Regular
Salary
$150,900.00 - $249,100.00 / yr
Benefits
Paid time off starting at 28 days per year, inclusive of vacation, personal/sick, and 7 Holidays
100% paid parental leave up to 6 weeks
Immediate eligibility for retirement plans with employer contribution up to 9.5%
Comprehensive medical, dental, vision plans in addition to employer paid disability and life insurance.
Comprehensive well-being programs including on-site employee fitness center located on Denver Health main campus and nationally recognized RESTORE Center
Free RTD EcoPass (public transportation)
Childcare discount programs & exclusive perks on large brands, travel, and more
Tuition reimbursement & assistance
Education, coaching, and professional development opportunities through the Workforce Development Center (WFDC) that support internal career growth and advancement pathways
Professional clinical advancement program & shared governance
Public Service Loan Forgiveness (PSLF) eligible employer+ free student loan coaching and assistance navigating the PSLF program
National Health Service Corps (NHCS) and Colorado Health Service Corps (CHSC) eligible employer