Senior Director, Pharmaceutical Services

Inland Empire Health Plans; Rancho Cucamonga, Northern (CA, KY); Hybrid; USD 180,000 - 240,000; Full time

Benefits offered by this job

Competitive salary

Hybrid schedule

On-site fitness center

Medical, dental, and vision insurance

Life, short-term and long-term-disabil

Career development opportunities

Wellness programs

Flexible Spending Account – Health/Dep

CalPERS retirement

457(b) with match

Pet care insurance

Job summary

Inland Empire Health Plans seeks a Senior Director of Pharmaceutical Services to lead the strategic direction, clinical oversight, and operational execution of IEHP's pharmaceutical program for Medi-Cal, DSNP, and Exchange members.

The role focuses on evidence-based utilization management, NCQA readiness, and cost containment, while aligning with CMS, DHCS, and DMHC requirements and driving PBM performance and improved member outcomes.

Qualifications

• Ten or more years leading pharmacy and PBM programs with budget responsibility.
• Experience driving CMS, DHCS, DMHC, NCQA readiness and improvement.
• Proven ability to lead clinical and operational teams to improve outcomes.

Responsibilities

• Lead strategic direction, clinical oversight, and operational execution of IEHP's pharmaceutical program.
• Ensure utilization management with evidence-based criteria and audit-ready documentation.
• Drive PBM performance, cost containment, and coordination with DHCS Medi-Cal Rx PBM.

Skills

Leadership

Regulatory knowledge

Strategic planning

Cost containment

Stakeholder negotiation

Team management

Communication

Clinical program oversight

Education

Pharm. D. from an accredited institution

MBA from an accredited institution

Job description

What you can expect!

Find joy in serving others with IEHP! We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an authentic experience!

Reporting to the Vice President, Pharmacy, the Senior Director, Pharmaceutical Services leads the strategic direction, clinical oversight, and operational execution of IEHP’s pharmaceutical program for IEHP Medi Cal, DSNP, and Exchange members, and is responsible for ensuring appropriate utilization management through evidence based UM criteria, audit ready documentation, and strengthened cost containment protocols. The role demonstrates advanced expertise in CMS, DHCS, DMHC, MDV audits and NCQA survey readiness and oversight, leading corrective action implementation and continuous quality improvement, while maintaining comprehensive regulatory compliance across DHCS, DMHC, CMS and NCQA. In addition, the Senior Director oversees the optimization of Pharmacy Benefit Management (PBM) performance, drives cost effective utilization, enhances member health outcomes, and ensures coordination of benefits and services with the DHCS Medi Cal Rx PBM, supporting IEHP’s strategic plans to improve chronic/preventative care, member experience, HEDIS, Stars and CAHPS performance.

Commitment to Quality: The IEHP Team is committed to incorporate IEHP’s Quality Program goals including, but not limited to, HEDIS, CAHPS, and NCQA Accreditation.

Perks

IEHP is not only committed to healing and inspiring the human spirit of our Members, but we also aim to match our team members with the same energy by providing prime benefits and more.

• Competitive salary.
• Hybrid schedule.
• State of the art fitness center on-site.
• Medical Insurance with Dental and Vision.
• Life, short-term, and long-term disability options
• Career advancement opportunities and professional development.
• Wellness programs that promote a healthy work-life balance.
• Flexible Spending Account – Health Care/Childcare
• CalPERS retirement
• 457(b) option with a contribution match
• Paid life insurance for employees
• Pet care insurance

Education & Requirements

• At least ten (10) years of experience in:
  • -Leading the strategic direction, operational efficiency, and financial performance of the pharmacy department. This role encompasses various responsibilities, including leading teams, managing budgets, ensuring compliance, and driving quality improvement initiatives
  • Senior level management, policy development and decision-making, with development and implementation of management best practices
  • Senior level management of a pharmacy benefit program spanning Medicare, Medi-Cal and Exchange
  • Pharmacy Benefit Management (PBM) oversight (CMS and Commercial)
  • Clinical knowledge in implementing quality and clinical pharmaceutical programs (CMS star rating programs, DHCS MCAS measure improvement, NCQA quality programs)
  • Leading and directing a team of clinical and operational pharmacists, pharmaceutical technicians, analysts, and special program managers
  • Annual budget management
• Past successes in:
  • Identifying trends or changes in treatment patterns and developing / implementing program changes to accommodate treatment changes
  • Implementing innovative cost containment policies and procedures
  • Implementing quality assurance programs
  • Empowering staff to succeed through education and appropriate work
• Pharm. D. from an accredited institution required
  • MBA from an accredited institution preferred
• Possession of an active, unrestricted, and unencumbered Registered Pharmacist license issued by the California State Board of Pharmacy required

Key Qualifications

• Comprehensive knowledge of:
  • CMS, DHCS, DMHC and NCQA pharmacy regulations
  • Business principles and techniques of administration, organization, and management within the healthcare industry
  • Strategic and operational planning
  • Healthcare economics
  • Personnel administration
  • Federal and state of California healthcare statutes, regulations, and rules
  • Healthcare industry trends
  • Negotiating with various pharmacy industry stakeholders
  • Regional pharmacy community
• Excellent writing and communication skills and excellent organizational skills
• Must have grit and attention to detail