Pharmacist - Part D

Medix; Tampa (FL); Vor Ort; USD 145.000 - 160.000; Vollzeit

Zusammenfassung

Medix Staffing Solutions, Inc. is seeking a Senior Director of Pharmacy (Medicare Part D) to own the entire Part D program, including formulary design, CMS compliance, and financial performance.

This on-site Tampa role reports to executive leadership and offers a base salary with performance bonuses and equity upside. The position requires a PharmD with direct Part D managed care experience, strong leadership, and a track record of optimizing costs and outcomes across Medicare populations.

Qualifikationen

• Doctor of Pharmacy (PharmD) or equivalent degree from an accredited institution.
• Direct Medicare Part D managed care experience preferred, with familiarity of CMS regulatory guidance and Part D workflows.
• Demonstrated ability to design, implement, and quantify clinical pharmacy cost-saving programs.
• Direct supervisory experience leading clinical or operational pharmacy personnel.

Aufgaben

• Direct the strategic development, maintenance, and submission of CMS Part D formularies.
• Oversee CMS-mandated member documents (ANOC, EOC, formulary, member letters).
• Lead drug class reviews with PBM, determine tier placement and utilization management parameters.
• Monitor CMS memos, call letters, and audit protocols for readiness.
• Manage PBM operations, ensuring SLAs and statutory obligations are met.
• Audit PBM contracts and performance metrics; ensure accurate claim adjudication.
• Conduct Drug Utilization Evaluations (DUE) to optimize prescribing and outcomes.
• Collaborate with MTM and Health Services on clinical interventions for Medicare populations.
• Drive Part D CMS Star Ratings initiatives and provider education materials.
• Perform claims analyses to identify spend drivers and optimization opportunities.
• Use predictive modeling to assess financial impact of formulary changes and new drugs.
• Document dollar-for-dollar savings and present to executives.
• Build and mentor the Medicare Part D pharmacy team.

Kenntnisse

PharmD

CMS regulations

PBM collaboration

Cost-saving programs

Ausbildung

Doctor of Pharmacy (PharmD)

Jobbeschreibung

Salary: USD145000 - USD160000 per year

Senior Director of Pharmacy (Medicare Part D)

Job Type: Full-Time

Schedule: Monday - Friday, Normal Business Hours

Compensation: Competitive Base Salary + Performance Bonus Tied to Quantifiable Cost Savings + Long-Term Equity Upside Potential

Location:On-Site - Tampa, FL 33609

About the Opportunity:

We are a rapidly growing, entrepreneurial Medicare Advantage organization led by an executive leadership team with a demonstrated record of multi-billion-dollar enterprise exits across major health plans (including WellCare, Freedom Health, and Optimum Healthcare). The company is actively executing on a high-growth roadmap targeting a strategic exit within the next 3–5 years.

We are seeking an agile, commercially minded clinical pharmacy executive to serve as our Director of Pharmacy. In this high-visibility position, you will own the entire Medicare Part D program—directing formulary design, PBM vendor execution, CMS compliance, clinical utilization, and financial performance.

This is not a siloed corporate role. You will sit at the table with the C-suite, collaborate directly with actuarial partners and MSOs, manage our Part D operational staff, and directly share in the bottom-line financial rewards of your cost-saving and quality initiatives.

Why This Role?

Meaningful Exit Equity: Join an organization led by serial healthcare entrepreneurs with a documented track record of successful exits; this role carries long-term equity upside targeting a 3–5 year horizon.

Incentive Alignment: Transparent, measurable bonus structure directly tied to the hard dollar savings and rebate efficiencies you deliver.

Broad Enterprise Exposure: Gain complete visibility across the full Medicare Advantage ecosystem—contracting, network operations, actuarial bid dynamics, MSO relations, and risk adjustment.

Career Springboard: Direct autonomy to shape clinical and operational workflows, positioning you for rapid advancement into VP or Chief Pharmacy Officer leadership.

Key Responsibilities:

Formulary Management & Regulatory Compliance

Direct the strategic development, maintenance, and submission of compliant Medicare Part D formularies consistent with CMS guidance, market trends, and clinical evidence.

Oversee the end-to-end production and regulatory accuracy of CMS-mandated member documents, including the Annual Notice of Change (ANOC), Evidence of Coverage (EOC), abridged/comprehensive formulary, and required member letters.

Lead medication class reviews in collaboration with our PBM, determining tier placement, utilization management parameters (PA, ST, QL), and new-to-market drug coverage strategies.

Monitor, operationalize, and enforce all CMS memos, call letters, and audit protocols to maintain continuous inspection readiness.

Manage daily and strategic operations with the Pharmacy Benefit Manager (PBM), holding them accountable to operational SLAs, performance guarantees, and statutory obligations.

Regularly audit PBM contracts, performance metrics, and point-of-sale claim adjudication to guarantee medications process accurately according to plan design.

Troubleshoot and resolve claims adjudication errors, transitional fill discrepancies, and coverage determination workflows.

Conduct robust Drug Utilization Evaluations (DUE) to ensure optimal prescribing, dispensing, and patient outcomes across the membership.

Align closely with Health Services and Medication Therapy Management (MTM) teams to design clinical interventions that address general and complex Medicare populations.

Spearhead initiatives to maximize Part D CMS Star Ratings performance (Triple-Weighted Adherence measures, Statin Use in Persons with Diabetes, and CMR completion rates).

Develop clinical education programs and clear formulary transition guides for network providers, Medical Service Organizations (MSOs), and members.

Perform detailed claims analyses across high- and low-utilization categories to uncover drug spend drivers and clinical optimization opportunities.

Leverage predictive modeling and forecasting to evaluate the financial impact of formulary adjustments, biosimilar conversions, and upcoming pipeline drugs.

Track and document dollar-for-dollar savings produced by internal clinical programs, presenting findings and actionable recommendations to executive leadership.

Supervise, mentor, and build out the internal Medicare Part D pharmacy team, cultivating high standards of clinical excellence, compliance, and accountability.

Qualifications

Doctor of Pharmacy (PharmD) or equivalent degree from an accredited institution.

Proven track record of direct Medicare Part D managed care experience, including deep familiarity with CMS regulatory guidance and Part D operational workflows.

Demonstrated ability to design, implement, and quantify clinical pharmacy cost-saving programs.

Direct supervisory experience leading clinical or operational pharmacy personnel.

Preferred Qualifications:

Prior operational experience inside a Pharmacy Benefit Manager (PBM).

Direct experience leading or supporting the annual CMS Part D formulary bid submission in partnership with actuarial consultants.

Documented success driving measurable gains in Part D CMS Star Ratings.

Strong background in claims data analytics and predictive utilization modeling.