Director – Pharmacy

Jobtailor; Monterey Park (CA); On-site; USD 180,000 - 260,000; Full time

Job summary

Astrana seeks a PharmD leader to build and oversee the pharmacy function, focusing on utilization management for provider-administered and specialty drugs, with emphasis on prior authorizations and clinical criteria.

The role requires managing cost-of-care initiatives, refining formulary and pathways, and shaping contracting strategy while collaborating with medical directors, care teams, and compliance. California licensure or pending is expected.

Qualifications

• Doctor of Pharmacy (PharmD) required (license active/unrestricted).
• California license required or willingness to obtain promptly.

Responsibilities

• Lead and build Astrana's pharmacy function as the first dedicated pharmacy leader for drug-related utilization management and clinical pharmacy strategy.
• Own end-to-end utilization management for provider-administered (J-code) and specialty drugs, including prior authorization review, clinical criteria, appeals, and complex case reviews.
• Design and lead cost-of-care initiatives involving biosimilar conversion, site-of-care optimization, dose optimization, white labeling, and Buy-and-Bill-to-Part D conversion.
• Develop and manage specialty pharmacy contracting strategy.
• Direct appropriate volume to Astrana's specialty pharmacy channel where clinically and financially appropriate.
• Partner with medical directors, care management, and network teams to build clinical pathways and formulary/UM criteria for high-cost specialty and infusion therapies.
• Build and maintain reporting and dashboards tracking drug spend trends, savings initiatives, and UM turnaround-time performance.
• Collaborate with Health Services, Network Management, Finance, and Compliance.
• Monitor the regulatory and payer landscape, including CMS, state Medicaid, and health plan formularies, and maintain compliance.
• Establish pharmacy policies, workflows, and documentation standards.
• Help scope and build the pharmacy team as volume and scope grow.

Skills

Utilization Management

Specialty Pharmacy Contracting

Cost-Of-Care Initiatives

Analytical Skills

J-Code Review

Biosimilar Conversion

Education

Doctor of Pharmacy (PharmD)

Tools

Reporting Dashboards

Compliance Monitoring

Job description

• Lead and build Astrana's pharmacy function as the first dedicated pharmacy leader for drug-related utilization management and clinical pharmacy strategy
• Own end-to-end utilization management for provider-administered (J-code) and specialty drugs, including prior authorization review, clinical criteria, appeals, and complex case reviews
• Design and lead cost-of-care initiatives involving biosimilar conversion, site-of-care optimization, dose optimization, white labeling, and Buy-and-Bill-to-Part D conversion
• Develop and manage specialty pharmacy contracting strategy
• Direct appropriate volume to Astrana's specialty pharmacy channel where clinically and financially appropriate
• Partner with medical directors, care management, and network teams to build clinical pathways and formulary/UM criteria for high-cost specialty and infusion therapies
• Build and maintain reporting and dashboards tracking drug spend trends, savings initiatives, and UM turnaround-time performance
• Collaborate with Health Services, Network Management, Finance, and Compliance
• Monitor the regulatory and payer landscape, including CMS, state Medicaid, and health plan formularies, and maintain compliance
• Establish pharmacy policies, workflows, and documentation standards
• Help scope and build the pharmacy team as volume and scope grow

Requirements

• Doctor of Pharmacy (PharmD) required
• Active, unrestricted pharmacist license required; California license required or willingness to obtain promptly
• 5+ years of experience in managed care pharmacy, PBM, or health plan utilization management
• Direct experience managing J-code/provider-administered specialty drug review
• Track record leading cost-of-care pharmacy initiatives such as biosimilar conversion, site-of-care optimization, or specialty pharmacy contracting
• Hands-on experience with utilization management workflows, prior authorization criteria design, and P&T governance processes
• Strong analytical skills, including building and tracking savings and ROI models for pharmacy programs
• Ability to balance strategic program-building with hands-on case review and day-to-day execution
• Cross-functional communication skills and experience partnering with medical directors, network, finance, and compliance teams
• Experience in a value-based care organization, IPA, MSO, or health plan strongly preferred
• Board certification such as BCPS or BCACP is a plus

Core Competencies

Demonstrates expertise in pharmacy utilization management, including prior authorization processes and specialty drug review, while effectively leading cost-of-care initiatives and collaborating across multidisciplinary teams. Proven ability to develop pharmacy policies and manage clinical pathways in compliance with regulatory standards.

Highest-signal resume keywords

• Doctor Of Pharmacy (PharmD)
• Utilization Management
• Specialty Pharmacy Contracting
• Cost-Of-Care Initiatives
• Analytical Skills

Hard Skills

• Utilization Management Workflows
• Prior Authorization Criteria Design
• J-Code Review
• Biosimilar Conversion
• Site-Of-Care Optimization
• Savings Tracking
• ROI Models
• Pharmacy Policies
• Clinical Pathways Development
• Formulary Management

Soft Skills

• Cross-Functional Communication
• Strategic Program-Building
• Hands-On Case Review

Certifications & Qualifications

• Active Pharmacist License
• Board Certification (BCPS or BCACP)

Industry Keywords

• Managed Care Pharmacy
• PBM
• Health Plan
• Value-Based Care
• CMS
• State Medicaid
• Health Plan Formularies

Tools & Technologies

• Reporting Dashboards
• Compliance Monitoring