Director of Pharmacy Operations & Medical Policy (Hybrid)

Cambia Health Solutions; Arkansas; Hybrid; USD 181,000 - 245,000; Full time

Benefits offered by this job

Medical, dental and vision coverage

Health Savings Account

Paid time off

401(k) with company match

Parental leave

Job summary

Cambia Health Solutions seeks a Director of Clinical Operations and Medical Policy to lead pharmacy prior authorization, clinical review, appeals, and formulary governance across markets. You will shape a scalable operating model connecting clinical decisions with affordability, regulatory expectations, and member experience.

You will build a high-performing team, align cross-functional partners, and drive transformational change while delivering measurable outcomes and strategic roadmaps for a

Qualifications

• PharmD or BS in Pharmacy and current pharmacist licensure in at least one U.S. jurisdiction.
• Eight+ years in managed-care pharmacy or related operations.
• Five+ years of formal leadership including people and cross-functional initiatives.
• Experience leading pharmacy clinical policy, prior authorization, appeals, formulary governance, or related operations across markets.
• Equivalent combinations of education and experience may be considered.

Responsibilities

• Provide vision and leadership for pharmacy clinical operations and medical policy across markets.
• Establish a policy-governance model with clear decision rights and interfaces.
• Build a forward-looking clinical strategy informed by drug trends and market needs.
• Own operational performance with KPIs, service levels, and financial impact.
• Lead transformation across people, process, technology, data, and governance.
• Partner across multiple teams to translate complex issues into clear options and actions.
• Maintain regulatory, accreditation, audit readiness, and contractual obligations.
• Create scalable, market-responsive capabilities and improve transparency in reviews.

Skills

Strategic thinking

People leadership

Clinical operations knowledge

Regulatory knowledge

Collaboration and influence

Executive presence

Communication skills

Multi-stakeholder management

Adaptability

AI tools experience

Education

Doctor of Pharmacy (PharmD) or Bachelor of Science in Pharmacy

MBA or related advanced degree

Job description

Cambia Health Solutions seeks a Director of Clinical Operations and Medical Policy to lead pharmacy prior authorization, clinical review, appeals, and formulary governance across markets. You will shape a scalable operating model connecting clinical decisions with affordability, regulatory expectations, and member experience.

You will build a high-performing team, align cross-functional partners, and drive transformational change while delivering measurable outcomes and strategic roadmaps for a