Dir, Pharmacy - Health Plan

Director, Pharmacy - Health PlanSummaCare - 1200 E Market St, Akron, OHFull-Time / 40 Hours / DaysHybrid We are seeking an experienced and strategic Director of Pharmacy to provide leadership and oversight of pharmacy benefit strategy, clinical programs, operations and performance. This role will partner closely with medical, clinical, finance, and business leaders to optimize medication utilization, improve member outcomes, manage pharmacy spend, and ensure compliance with applicable regulatory requirements. The ideal candidate is a collaborative healthcare leader with strong pharmacy expertise, business acumen, and experience working within a health plan, PBM, or managed care environment. Summary:Provides Clinical Pharmacological leadership to the Health plan, membership and provider network. Provides oversight for pharmacy and therapeutic issues, and ensures compliance with pertinent government regulations and standards.1. Formal Education Required:a. Advanced Degree or may substitute with 6 years of like experience.2. Experience and Training Required:a. 5+ years performing same or similar responsibilities. Relevant experience includes: working in Pharmacy Benefit Management either in a Health Insuring Corporation or other managed care environment and experience working with Medicare Part D. b. Minimum 5 years direct supervisory experience also required.c. Registered Pharmacist in State of Ohio.Essential Functions: 1. Reviews, monitors and recommends changes to prescription programs and formulary including limitations, pre-authorizations, exceptions and non-covered items. Oversees development and administration of Medicare Part D formulary.2. Designs, develops, implements highly complex programs, products, technical systems, policies that affect overall direction of the company. Proofreads completed work to find and correct errors. 3. Oversees selection, implementation, and performance of the Pharmacy Benefit Manager (PBM).4. Assures regulatory compliance of the Pharmacy Department. Provides guidance to staff on operational and regulatory issues including compliance with CMS (Medicare MA and Part D), NCQA, Fraud Waste & Abuse, and ODI guidelines.5. Develops and analyzes drug utilization reports, and makes recommendations to Senior Management for interventions. 6. Oversees Contracting Strategies as related to Pharmacy and Therapeutic issues. Manages Pharmacy & Therapeutics Committee including development of agendas and meeting materials. Reviews all committee actions and recommendations with Clinical Pharmacist and Chief Medical Director. 7. Serves as resource to HSM staff and Sales staff for drug information and consultation to on individual patient situations. Provides benefit consultation services to SummaCare clients including Summa entities, and participates in client meetings, presentations, and performance reporting to key accounts.8. Oversees coverage determinations. Acts as initial review for coverage requests as well as for drugs covered under medical benefit. Reviews first-line appeals, when original review was conducted by PBM.9. Establishes relationships with managed care divisions of pharmaceutical manufacturing representatives.10. Develops, implements, and oversees utilization and disease management programs and incentives designed to improve quality of care, member medication compliance, and maintain cost-effectiveness.11. Performs all job functions with integrity. Provides timely internal and external customer service in cooperative, professional and respectful manner.3. Other Skills, Competencies and Qualifications:a. Requires excellent attention to detail.b. Strong Analytical skills. Designs, develops, implements highly complex programs, products, technical systems, policies that affect overall direction of the company. c. Requires excellent attention to detail.d. Strong Proofreading skills to review completed work to find and correct errors. e. Read, analyze, and interpret general business periodicals, professional journals, technical procedures, and government regulations.f. Demonstrate strong leadership and managerial skills.g. Make sound decisions and recommendations based on consideration of facts, priorities, resources, and alternatives.h. Organize and manage time to accurately complete tasks within designated time frames in fast-paced environment.i. Maintain current knowledge of and comply with regulatory and company policies & procedures.j. Ability to communicate complex information verbally and in written form that may include policies and procedures, financial, legal, and/or technical documents, and opinion papers.k. Ability to provide guidance required to implement strategic programs and projects; ability to supervise work within and/or across departments. l. Ability to negotiate and persuade professionals, board members, general public.m. Maintain confidentiality of patient and business information.n. Flexible: ability to adjust work hours to meet business demands.o. Ability to travel from location to location throughout the workday.p. Population Specific Competency: Ability to effectively interact with patients/customers with the understanding of their needs for self-respect and dignity4. Level of Physical Demands:a. Light: Exerts up to 20 pounds of force occasionally and/or up to ten pounds of force frequently, and/or a negligible amount of force continuously.Based in Akron, Ohio, SummaCare provides Medicare Advantage, individual and family and commercial insurance plans. SummaCare has one of the highest rated Medicare Advantage plans in the state of Ohio, with a 4.5 out of 5-Star rating for 2026 by the Centers for Medicare and Medicaid Services (CMS). Known for its excellent customer service and personalized attention to members, SummaCare is committed to building lasting relationships. Employees can expect competitive pay and benefits.Equal Opportunity Employer/Veterans/Disabled$80.17/hr - $120.26/hrThe salary range on this job posting/advertising is base salary exclusive of any bonuses or differentials. Many factors, such as years of relevant experience and geographical location are considered when determining the starting rate of pay. We believe in the importance of pay equity and consider internal equity of our current team members when determining offers. Please keep in mind that the range that is listed is the full base salary range. Hiring at the maximum of the range would not be typical.Summa Health offers a competitive and comprehensive benefits program to include medical, dental, vision, life, paid time off as well as many other benefits.Basic Life and Accidental Death & Dismemberment (AD&D)Supplemental Life and AD&DDependent Life InsuranceShort-Term and Long-Term DisabilityAccident Insurance, Hospital Indemnity, and Critical IllnessRetirement Savings PlanFlexible Spending Accounts – Healthcare and Dependent CareEmployee Assistance Program (EAP)Identity Theft ProtectionPet InsuranceEducation AssistanceDaily PayJob SummaryJob Type: FTEmployment Type: EMPLOYEELocation: Akron, OH, US