Lead, direct, and oversee all clinical aspects of current and future pharmacy benefit programs, ensuring appropriate policies, procedures and resources are in place and aligned with all applicable regulations and requirements
Directs and manages staff responsible for the development and implementation of new and revised clinical pharmacy services across pharmacy and medical management; ensures strategic alignment of clinical services across the enterprise where appropriate
Directs and oversees all aspects of staff and any vendor(s) performing case review for the pharmacy care management programs, member appeals, grievances and complaints all within the established time periods
Leads the management of appropriate drug utilization through formulary creation, clinical criteria development, and utilization management activities, including prior authorization and appeals

Doctor of Pharmacy (PharmD) Degree
7 years
Senior leadership-level experience and documented record of success in management of multi-disciplinary pharmacy operations required
Competency in compendia navigation and research
Outstanding negotiation, presentation, and facilitation skills
Excellent oral and written communication skills
Adaptive to high pace and changing environment
Proven effective supervisory and leadership traits to manage and direct others
Knowledge of medical and pharmacy products
Basic understanding of provider reimbursement methodologies, including fee schedule pricing, DRG reimbursement, bundled outpatient hospital payment mechanisms, capitation, risk sharing arrangements and other payment methodologies
Demonstrated consumer healthcare market understanding/knowledge required
Licensed in Tennessee to practice Pharmacy, or eligible for licensure in the state of Tennessee to practice Pharmacy

Director, Clinical Pharmacy

Key skills