Pharmacy Director

Job Title: Pharmacy Director

Department: Health Services

Reports To: Chief Medical Director

FLSA Status: Exempt

Prepared By: COO

Prepared Date: 07/22/2025

Position Overview

The Director of Pharmacy is responsible for the leadership and management of the Medicare Part D program and formulary bid design for Ultimate Health Plans, Inc. The ideal candidate will provide strategic and tactical guidance to ensure successful pharmacy operations and program compliance within the pharmacy department, CMS, and NCQA regulations. This individual will be integral in identifying opportunities to improve HEDIS and Stars measures as well as managing the Medicare Part D program. This individual will develop and lead programs to lower pharmaceutical costs and improve outcomes for Ultimate members across all IPAs. This position will augment the work of the Population Health team and reports to the Chief Medical Officer.

Essential Duties and Responsibilities

Reviews, develops, and implements Medicare guidance and protocols to ensure compliance with contract.

Provides clinical pharmaceutical leadership for the health plan by managing the custom formularies, developing Medicare Part D programs, ensuring programming of formulary medications and quality management.

Audits PBM contracts and results to ensure contract obligations and CMS requirements.

Works with the PBM to ensure medication class reviews are completed and consistent with CMS guidelines. Directs the status of new medications placed on the Medicare formularies consistent with best practices and market requirements.

Prioritizes new initiatives to improve pharmaceutical management, identifies and measures clinical and financial outcomes for these initiatives.

Utilizes risk stratification to identify targeted high-risk patient populations by age, hospitalizations, diagnoses (e.g., COPD, CHF, CVD, and DM), and polypharmacy to better manage the population.
Disseminates education and formulary related information between the plan and the PBM Program, Network Providers, MSOs, Provider Relations services, and Health Services to improve member's quality outcomes.

Identifies opportunities to increase generic utilization, reduce drug expenditures, and develop key clinical programs/protocols using a data-driven approach.

Develops and maintains protocols to guide prescribing therapy for select disease states, optimizing the use of each of Ultimate's formularies and generic/cost-efficient therapeutic alternatives.
Oversees medication therapy management/disease state management for patient populations with high pharmacy expenses or significant opportunities for improvement.

Works with the operations division in ensuring clinical outcomes and best practices.

Conducts drug utilization evaluations to foster best practices in prescribing, dispensing, administration and monitoring of outcomes.

Coordinates educational sessions on medication therapy for Ultimate members as needed; educates prescribers regarding the use of safe, efficient and cost-effective medication therapies for highly utilized medications; serves as a resource to suggest pharmacotherapy alternatives to enhance compliance, reduce potential errors/adverse drug events, and minimize cost burden.

Collaborate with key areas of the organization to ensure expectations of internal and external stake holders of the pharmacy program are met including compliance, UM, quality, population health, IT/IS, operations, actuarial, finance, data and analytics and sales.

Participates and reports pharmaceutical and plan management findings in internal committees.

Carries out special projects as assigned; designs develop and maintains analyses and reports, including graphic presentation and dissemination.

Supports and participates in other duties as required.

Competencies

To perform the job successfully, an individual should demonstrate the following competencies:

Analytical - Synthesizes complex or diverse information; Collects and researches data; Uses intuition and experience to complement data; Designs workflows and procedures.

Design - Generates creative solutions; Demonstrates attention to detail.

Problem Solving - Identifies and resolves problems in a timely manner; Gathers and analyzes information skillfully; Develops alternative solutions; Works well in group problem-solving situations; Uses reason even when dealing with emotional topics.

Project Management - Coordinates projects; Manages project team activities.

Technical Skills - Assesses own strengths and weaknesses; Pursues training and development opportunities; Strives to build knowledge and skills continuously; Shares expertise with others.

Customer Service - Manages difficult or emotional customer situations; Responds promptly to customer needs; Responds to requests for service and assistance; Meets commitments.

Interpersonal Skills - Focuses on solving conflict, not blaming; Maintains confidentiality; Listens to others without interrupting; Keeps emotions under control; Remains open to others' ideas and tries new things.

Oral Communication - Speaks clearly and persuasively in positive or negative situations; Listens and gets clarification; Responds well to questions; Demonstrates group presentation skills; Participates in meetings.

Written Communication - Writes clearly and informatively; Edits work for spelling and grammar; Varies writing style to meet needs; Presents numerical data effectively; Able to read and interpret written information.

Teamwork - Balances team and individual responsibilities; Exhibits objectivity and openness to others' views; Gives and welcomes feedback; Contributes to building a positive team spirit; Puts success of team above own interests; Able to build morale and group commitments to goals and objectives; Supports everyone's efforts to succeed.

Visionary Leadership - Displays passion and optimism; Inspires respect and trust; Mobilizes others to fulfill the vision; Provides vision and inspiration to peers and subordinates.

Change Management - Develops workable implementation plans; Communicates changes effectively; Builds commitment and overcomes resistance; Prepares and supports those affected by change; Monitors transition and evaluates results.

Delegation - Delegates work assignments; Matches the responsibility to the person; Gives authority to work independently; Sets expectations and monitors delegated activities; Provides recognition for results.

Leadership - Exhibits confidence in self and others; Inspires and motivates others to perform well; Effectively influences actions and opinions of others; Accepts feedback from others; Gives appropriate recognition to others.

Managing People - Includes staff in planning, decision-making, facilitating and process improvement; Takes responsibility for subordinates' activities; Makes self-available to staff; Provides regular performance feedback; Develops subordinates' skills and encourages growth; Solicits and applies customer feedback (internal and external); Fosters quality focus in others; Improves processes, products, and services.; Continually works to improve supervisory skills.

Quality Management - Looks for ways to improve and promote quality; Demonstrates accuracy and thoroughness.

Business Acumen - Understands business implications of decisions; Displays orientation to profitability; Demonstrates knowledge of market and competition; Aligns work with strategic goals.

Cost Consciousness - Works within approved budget; Develops and implements cost-saving measures; Contributes to profits and revenue; Conserves organizational resources.

Diversity - Demonstrates knowledge of EEO policy; Shows respect and sensitivity for cultural differences; Educates others on the value of diversity; Promotes a harassment-free environment; Builds a diverse workforce.

Ethics - Treats people with respect; Keeps commitments; Inspires the trust of others; Works with integrity and ethically; Upholds organizational values.

Organizational Support - Follows policies and procedures; Completes administrative tasks correctly and on time; Supports organization's goals and values; Benefits organization through outside activities; Supports affirmative action and respects diversity.

Strategic Thinking - Develops strategies to achieve organizational goals; Understands organization's strengths & weaknesses; Analyzes market and competition; Identifies external threats and opportunities; Adapts strategy to changing conditions.

Judgment - Displays willingness to make decisions; Exhibits sound and accurate judgment; Supports and explains reasoning for decisions; Includes appropriate people in decision-making process; Makes timely decisions.

Motivation - Sets and achieves challenging goals; Demonstrates persistence and overcomes obstacles; Measures self against standard of excellence; Takes calculated risks to accomplish goals.

Planning/Organizing - Prioritizes and plans work activities; Uses time efficiently; Plans for additional resources; Sets goals and objectives; Organizes or schedules other people and their tasks; Develops realistic action plans.

Professionalism - Tactfully approaches others; Reacts well under pressure; Treats others with respect and consideration regardless of their status or position; Accepts responsibility for own actions; Follows through on commitments.

Quality - Demonstrates accuracy and thoroughness; Looks for ways to improve and promote quality; Applies feedback to improve performance; Monitors own work to ensure quality.

Quantity - Meets productivity standards; Completes work in a timely manner; Strives to increase productivity; Works quickly.

Safety and Security - Observes safety and security procedures; Determines appropriate action beyond guidelines; Reports potentially unsafe conditions; Uses equipment and materials properly.

Adaptability - Adapts to changes in the work environment; Manages competing demands; Changes approach or method to best fit the situation; Able to deal with frequent change, delays, or unexpected events.

Attendance/Punctuality - Is consistently at work and on time; Ensures work responsibilities are covered when absent; Arrives at meetings and appointments on time.

Dependability - Follows instructions, responds to management direction; Takes responsibility for own actions; Keeps commitments; Commits to long hours of work when necessary to reach goals.; Completes tasks on time or notifies appropriate person with an alternate plan.

Initiative - Volunteers readily; Undertakes self-development activities; Seeks increased responsibilities; Takes independent actions and calculated risks; Looks for and takes advantage of opportunities; Asks for and offers help when needed.

Innovation - Displays original thinking and creativity; Meets challenges with resourcefulness; Generates suggestions for improving work; Develops innovative approaches and ideas; Presents ideas and information in a manner that gets others' attention.

Qualifications

Extensive experience with Medicare Part D formulary administration, accurate claims adjudication, and Prescription Drug Event (PDE) processing.

Experience with Medicare standards required.

Individuals should be detail-oriented with strong organization, prioritization, and analytical skills with the ability to work independently.

Must work well under tight timelines and adapt quickly to change in a fast-paced, team-oriented, and high-growth environment.

Located in Florida, preferred

Education and Experience

Current/Eligible for licensure in the State of Florida

Doctor of Pharmacy (Pharm D) degree

Five (5) to ten (10) years of experience working with Medicare Part D preferred

Computer Skills

To perform this job successfully, an individual should have an expert working knowledge of Microsoft Office software, including Microsoft Excel, Access, and Word, as well as MS Internet Explorer.

Other Qualifications

At least five (5) to ten (10) years previous practice experience required, previous Managed Care and Medicare health plan experience, and knowledge required.

Physical Demands The physical demands described here are representative of those that must be met by an employee to perform the essential functions of this job successfully. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is regularly required to talk or hear. The employee must occasionally lift and/or move up to 10 pounds.

Work Environment The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Job Type: Full-time

Pay: $170,000.00 - $190,000.00 per year

Benefits:

• 401(k)
• Dental insurance
• Flexible spending account
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• Monday to Friday

Work Location: Hybrid remote in Spring Hill, FL 34609

Salary : $170,000 - $190,000