Provides strategic leadership for clinical pharmacy initiatives across all lines of business
Oversee formulary, criteria, and prior authorization activities to ensure timely, compliant, and high-quality service delivery
Accountable for monitoring drug utilization trends, guiding performance standards, and ensuring regulatory compliance to support affordability and member outcomes
Lead the strategic direction, development, and execution of drug management programs
Direct leadership staff responsible for formulary creation, criteria development and maintenance, prior authorization evaluations, and utilization management monitoring
Oversee development and maintenance of clinical pharmacy policies and ensure compliance with accreditation standards (e.g., URAC, NCQA, CMS)
Lead and develop a high-performing team, fostering a culture of accountability, engagement, and continuous improvement, and professional growth
Coordinate with pharmacy benefit strategy leaders and corporate stakeholders to deliver competitive and cost-effective clinical services
Lead audit preparation and compliance initiatives to ensure coverage review operations meet internal and external standards
Ensure clinical functions meet expectations for value and affordability, driving continuous improvement and market responsiveness

Doctor of Pharmacy (PharmD) degree required
Minimum 10 years of managed care, PBM, and/or clinical experience required
Minimum 5 years of supervisory/leadership responsibilities required
Licensed in Tennessee to practice pharmacy, or eligible for licensure in the state of Tennessee to practice pharmacy
Ability to lead coverage review operations and ensure compliance
Expertise in policy development and audit readiness
Skill in driving process improvements for service quality
Strength in cross-functional collaboration with pharmacy and corporate teams
Leadership in building and mentoring operational teams

Managing Director, Clinical Pharmacy Strategy, Execution

Key skills