Sr Director, Pharmacy Management

Job Description:

Sr Director, Pharmacy Management

Description

Sr Director, Pharmacy Management

CalOptima

Join Us in this Amazing Opportunity

The Team You'll Join

We are a mission driven community-based organization that serves member health with excellence and dignity, respecting the value and needs of each person. If you are ready to advance your career while making a difference, we encourage you to review and apply today and help us build healthier communities for all.

More About the Opportunity

We are hoping you will join us as a Sr Director, Pharmacy Management and help shape the future of healthcare where you'll be an integral part of our Pharmacy Management team, helping to strive for excellence while we serve our member health with dignity, respecting the value and needs of each of our members through collaboration with our providers, community partners and local stakeholders. Under the direction of the CMO, you will be responsible for strategic planning and leadership, regulatory compliance, and management as well as operational oversight for all aspects of pharmacy services within a managed care organization, including Medi-Cal, Medicare Advantage Part D (HMO D-SNP), and Covered California. You will also be responsible for designing, implementing, and evaluating pharmacy benefit programs that align with clinical goals, financial sustainability, regulatory compliance, and member outcomes. You will develop and direct formulary strategy, utilization management, quality initiatives, and vendor performance-including Pharmacy Benefit Manager (PBM) oversight-and serves as the organization's principal pharmacy advisor to executive leadership and the Board of Directors. You will ensure compliance with Centers for Medicare & Medicaid Services (CMS), state Medicaid, Covered California, Department of Managed Health Care (DMHC), and National Committee for Quality Assurance (NCQA) standards while advancing initiatives to improve population health, medication adherence, and cost-effective drug use. You will be accountable for pharmacy-related quality programs and will contribute to the improvement of CalOptima Health's quality performance including but not limited to Star ratings.

This position will require a dynamic, data-driven leader with extensive experience in managed care pharmacy, cross-functional collaboration, and a strong understanding of the regulatory environment governing Medicare, Medicaid, and commercial health plans. You will ensure alignment with CalOptima Health's mission to serve member health with excellence and dignity, respecting the value and needs of each person through collaboration with our providers, community partners and local stakeholders. Together, we are building a stronger, more equitable health system.

Your Contributions To the Team:

• 60% - Leadership Responsibilities
  • Cultivates and promotes a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.
  • Directs and oversees the Pharmacy department in carrying out all department responsibilities and collaborates with the leadership team and staff to support short- and long-term goals and priorities.
  • Leads, develops, and implements pharmacy business plan and strategic initiatives in alignment with CalOptima Health's objectives and community mission, while taking ownership of both short- and long-term direction of the department.
  • Supports CalOptima Health's quality goals by driving improvements in Covered California Quality Transformation Initiative, Star Ratings, Pharmacy Quality Alliance (PQA) adherence measures, Healthcare Effectiveness Data and Information Set (HEDIS) outcomes, and other not yet identified quality programs.
  • Delivers effective service management through the definition and adoption of a governance practice that uses key performance indicators (KPIs) and metrics to track and measure the quality of service. Continually monitors metrics and the integration of them with key accountabilities to ensure consistency of approach and continual service improvement.
  • Oversees and ensures pharmacy management operational compliance with organizational standards, policies and procedures, and regulatory requirements while maintaining knowledge of related changes and developing effective communication plans as needed.
  • Serves as pharmacy subject matter expert to the executive team and CalOptima Health's Board of Directors.
  • Directs all aspects of running an efficient Pharmacy team, including hiring, supervising, coaching, developing, disciplining, motivating as well as attracting and retaining a high-performing team that achieves department goals that are in alignment with the CalOptima Health Strategic Plan.
  • Develops, implements, and upholds departmental policies and procedures.
  • Collaborates with CMO to develop and monitor annual budgets and corresponding business cases to ensure utilization meets strategic, operational, and budgetary goals.
  • Collaborates with CMO to manage staffing model and succession planning, and monitors related resource allocation for the department.
  • Collaborates with CMO and other senior leaders to develop projections for future year utilization and cost trends.
  • Supports senior leadership within CalOptima Health to drive and lead changes by communicating goals clearly and developing relationships with key stakeholders.
  • Serves in a Pharmacy and Therapeutics (P&T) Committee Leadership role.
  • Collaborates with leadership and staff across internal departments to share information, support organization goals, and promote positive and collaborative business relationships with vendors and providers.
    
    
• 35% - Program Operations Oversight
  • Leads and manages all pharmacy-related operational and clinical functions, including but not limited to formulary development, prior authorization protocols, and utilization management for Medi-Cal, Medicare, and Covered California lines of business as appropriate.
  • Directs the Pharmacy team, including clinical pharmacists, pharmacy operations, and analytic staff, fostering a culture of continuous improvement, excellence and innovation, and promotes collaboration between the Pharmacy team and other internal departments and external providers.
  • Oversees new program development related to pharmacy, including overseeing new program design and implementation for the Covered California line of business.
  • Collaborates with internal departments (Medical Management, Quality, Compliance, Finance, line-of business leaders, etc.) to optimize member outcomes and drug cost-effectiveness.
  • Ensures compliance with state and federal regulations, including CMS, DMHC, Covered California, and Medi-Cal Rx.
  • Leads Pharmacy Benefit Manager (PBM) procurement, contracting, implementation, oversight and vendor management, including contract negotiation, performance evaluation, and rebate management. PBM oversight is a critical requirement of this role including real time oversight of PBM Point of Service prescription fulfillment.
  • Collaborates with CMO to provide financial oversight, budget planning, and reporting for pharmacy benefit expenditures, ensuring transparency and fiscal responsibility.
  • Develops and oversees pharmacy-related internal statistical and performance reports and satisfies reporting requirements to external regulators.
  • Develops, implements, and monitors department's performance standards.
  • Manages audit preparation and corrective action plans in response to CMS, DHCS, and other regulatory bodies.
    
    
• 5% - Completes other projects and duties as assigned.

Do You Have What the Role Requires?

• Doctor of Pharmacy (PharmD) PLUS 7 years of health plan experience in Medicare Part D and Medicaid required.
  
• 5 years of pharmacy management experience with implementation of commercial managed care products, such as products sold on state-based exchanges/Covered California required.
  
• 3 years of progressive pharmacy leadership experience within a managed care, health plan, or PBM environment required.
  
• Demonstrated success in directing and overseeing pharmacy benefit strategy, regulatory compliance, and PBM/vendor contracts required.
  
• Experience with CMS audits, DHCS guidelines, and California Medicaid programs required.

You'll Stand Out More If You Possess the Following:

• 15 years of health plan and pharmacy experience in Medicare Part D and Medi-Cal.
  
• Pharmacy Residency in Managed Care or Pharmacy Practice.

What the Regulatory Agencies Need You to Possess?

• A current, valid and unrestricted California State Pharmacy License and PharmD.

Your Knowledge & Abilities to Bring to this Role:

• Develop rapport and establish and maintain effective working relationships with CalOptima Health's leadership and staff and external contacts at all levels and with diverse backgrounds.
• Work independently and exercise sound judgment.
• Communicate clearly and concisely, both orally and in writing.
• Work a flexible schedule; available to participate in evening and weekend events.
• Organize, be analytical, problem-solve and possess project management skills.
• Work in a fast-paced environment and in an efficient manner.
• Manage multiple projects and identify opportunities for internal and external collaboration.
• Motivate and lead multi-program teams and external committees/coalitions.
• Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment.

Your Physical Requirements (With or Without Accommodations):

• Ability to visually read information from computer screens, forms and other printed materials and information.
• Ability to speak (enunciate) clearly in conversation and general communication.
• Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face-to-face interactions.
• Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting.
• Lifting and moving objects, patients and/or equipment 10 to 25 pounds

Ways We Are Here For You

• You'll enjoy competitive compensation for this role.
  • Our current hiring range is: Pay Grade: 324 - $216,737 - $346,778 ($104.20 - $166.7201).
    • The final salary offered will be based on education, job-related knowledge and experience, skills relevant to the role and internal equity among other factors.
      
      
• This position is approved for Full Office (**If the position is Telework, it is eligible in California only**)
• A comprehensive benefits package
• CalPERS pension program and additional retirement packages.
• Additional benefits and perks including:
  • A generous PTO program
  • A quality work life balance
  • Various wellness programs
  • Tuition Reimbursement
  • Professional development opportunities
  • Career development opportunities
  • Flexible scheduling
  • And the satisfaction of knowing your work directly impacts and improves healthcare access for thousands of individuals and families.

Our Work Environment:

If located at the 500, 505 Building or a remote work location:

• Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed.
• There are no harmful environmental conditions present for this job.
• The noise level in this work environment is usually moderate.

If located at PACE:

• Work is typically indoors in a clinical setting serving the frail and elderly.
• There may be harmful or hazardous environmental conditions present for this job.
• The noise level in this work environment is usually moderate to loud.

If located in the Community:

• Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed.
• Employee will occasionally work outdoors in varied temperatures.
• There may be harmful or hazardous environmental conditions present for this job.
• The noise level in this work environment is usually moderate to loud.

Why Join Us?

We believe that diverse perspectives drive innovation. Each employee brings a unique perspective to the overall team and we value everyone's input and we are committed to creating an inclusive environment where you and every team member can thrive while making a meaningful impacts on our community members. Our team reflects and represents the communities we serve, and we welcome candidates from all backgrounds who share our commitment to accessible, quality healthcare.

What's Your Next Step?

All Applications will be accepted on a continuous basis until a sufficient number of qualified applications have been received. Do NOT miss out. If you want to join our team, the deadline for the first review of applications is December 7, 2025 at 9:00 PM (PST). We are encouraging you to apply early. If you apply after the first review date, your application is not guaranteed to be considered for this recruitment. This recruitment may close at any time without notice after the first review date.

Our Commitment to You

Your application and resume will be reviewed by a dedicated recruiter to this position. If your experience matches what we need, we will reach out to you to discuss the next steps. The selection process may include, but is not limited to, a skills assessment, phone screen and interview.

If you make it through the steps above and are selected for this exciting role, you will be required to undergo a reference and a background check (to include a conviction record) and if applicable also pass a drug screening and/or a post-offer pre-employment medical examination (for specific positions) If you are an Internal CalOptima Health applicant, please apply through the internal portal on InfoNet.

We will make sure to keep you updated through each step of the process on your candidate portal. Please make sure to watch for updates on your candidate portal and you emails which will be sent to the email address you listed on your application. Please check your email, including your SPAM folder, regularly throughout the recruitment process.

CalOptima Health is committed to attracting, hiring, and retaining a diverse staff, where we will honor your unique experiences, identity, and perspectives. Our organization strives to create and maintain a workplace environment that is inclusive, equitable and welcoming so we can truly be Better Together.

CalOptima Health is an equal opportunity employer and makes all employment decisions on the basis of merit. CalOptima Health wants to have qualified employees in every job position. CalOptima Health prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. CalOptima Health also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics.

If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation at (714) 246-8400 if you are unable or limited in your ability to access job openings or apply for a job on this site as a result of your disability.


To apply, please visit: https://jobs.caloptima.org/jobs/sr-director-pharmacy-management-505-city-parkway-west-california-united-states







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