Director Pharmacy Benefit Services Health Plans - Pharmacy Benefits Management

Summary:

CHRISTUS Health is seeking a strategic and visionary Director of Pharmacy Benefit Services to lead pharmacy operations across our Medicare Advantage and Health Insurance Exchange (HIX) plans for individual and small group markets. Ensures that all federal and state laws, rules and regulations, hospital/departmental policies, and procedures are followed in all aspects of This role is ideal for a dynamic leader with strong financial acumen, deep managed care expertise, and a passion for improving patient outcomes through innovative pharmacy solutions.

Responsibilities:

• Meets expectations of the applicable OneCHRISTUS Competencies: Leader of Self, Leader of Others, or Leader of Leaders.

Strategic Leadership

• Develops and executes enterprise pharmacy strategies aligned with CHRISTUS Health's REACH 2030 goals, utilizing strong analytical and financial skills.
• Represents CHRISTUS in internal governance and external forums (CMS, AMCP, PBM engagements).
• Leads initiatives including PBM procurement, formulary optimization, and rebate audits.
• Provides essential leadership and administrative support to the department members; coordinates the allocation of staff and other resources; Facilitates the ongoing achievement of the department's mission and goals; promotes the development and improvement of processes directed at providing quality, economical healthcare services.

Operational Oversight

• Manages pharmacy benefit operations: formulary management, prior authorizations, coverage determinations, appeals, and member outreach.
• Interdepartmental collaboration with Medical Management, Compliance, Regulatory Affairs, Complaints, Appeals, and Grievances (CAG), and Quality Management and others.
• Implements scalable infrastructure and automation to support growth.

Financial Management

• Oversees pharmacy P&L, budgeting, forecasting, and cost containment.
• Conducts audits and contract evaluations to optimize spend and rebate performance.
• Monitors KPIs including STAR ratings, adherence metrics, and cost savings dashboards.

Compliance & Governance

• Ensures compliance with CMS, Medicare Part D regulations and NCQA accreditation standards.
• Participates in enterprise governance committees (Policy & Procedure, Compliance, Medical Economics, and Quality Improvement).
• Manages pharmacy benefit services, facilitate drug utilization initiatives, integrate clinical pharmacy programs, oversee pharmacy information systems, advance medication safety, and assure regulatory compliance.

Team Development

• Directly manages the activities of pharmacists and technicians and are actively involved in their areas of oversight to ensure pharmacy associates remain competent and engaged in customer service, standardized work, and lean processes.
• Fosters a culture of accountability, innovation, and continuous learning.
• Supports professional development through training and certification.
• Possesses exceptional leadership and communication abilities.

Job Requirements:

Education/Skills

• Doctor of Pharmacy (PharmD) or equivalent clinical degree required
• MBA or MHA preferred

Experience

• 7+ years of leadership experience in managed care pharmacy, including Medicare Part D and HIX, required
• 8-12 years of practical experience preferred
• Deep understanding of PBM operations and regulatory frameworks

Licenses, Registrations, or Certifications

• RPH License in the state of employment required

In accordance with the CHRISTUS Health License, Certification and Registration Verification Policy, all Associates are required to obtain the required certifications for their respective positions within the designated time frame.

Work Schedule:

8AM - 5PM Monday-Friday

Work Type:

Full Time