Pharmacy Director, Health Plan

Job Description

Location: Nashville, TN

We are hiring for a Pharmacy Director, Health Plan with a regional health plan located in Nashville, TN. This position is a full-time, direct hire opportunity.

Responsibilities:

• Serve as enterprise pharmacy authority across all lines of business ensuring competitive, compliant benefit designs.
• Lead Pharmacy and Therapeutics Committee to develop evidence-based formulary management and clinical monographs.
• Oversee drug utilization management including prior authorization, step therapy, and quantity limit protocols.
• Direct specialty pharmacy strategy including site-of-care optimization, distribution management, and biosimilar conversion.
• Manage PBM vendor relationships including contract monitoring, rebate reconciliation, and RFP negotiations.
• Design and evaluate clinical programs targeting Stars measures, HEDIS gaps, and MTM quality.
• Monitor emerging drug trends including cell therapies, GLP-1 agents, and oncology innovations.
• Ensure CMS Medicare Part D compliance, Medicaid PDL alignment, and NCQA accreditation standards.
• Partner with Finance and Actuarial teams on pharmacy trend reporting and bid development.

Qualifications:

• Obtain PharmD from ACPE-accredited institution; complete PGY1/PGY2 in managed care, ambulatory care, or health system pharmacy.
• Obtain BCPS, BCACP, or BCBSM-recognized specialty certification; candidates without certification must achieve within 12 months.
• Maintain active, unrestricted pharmacist license; obtain Tennessee licensure within 90 days of hire.
• Demonstrate 7 years pharmacy: 4 in health plans/managed care/PBM, 3 in leadership roles.
• Demonstrate deep knowledge of Medicare Part D, CMS formulary requirements, Medicaid PDL, commercial benefit design.
• Lead P&T committees, build clinical utilization management programs, present evidence-based drug policy recommendations.

Schedule:

• Full-time, Monday through Friday
• On-site in Nashville, TN with some hybrid flexibility
• Standard business hours

Salary Range: The salary range for this position is approximately $130,000 – $165,000 annually ($62.50 – $79.33 per hour), based on experience and qualifications.

Interview Process:

• Selected candidates will participate in a multi-step interview process, including an initial screening with TalentLNX followed by interviews with department leadership.

Equal Opportunity Employer: TalentLNX is committed to equal employment opportunity and a diverse, inclusive workforce. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status.