Strategic Director, Clinical Operations & Medical Policy

Cambia Health Solutions; Fargo (ND); Hybrid; USD 167,000 - 245,000; Full time

Benefits offered by this job

Health coverage and benefits

Retirement plan with 401(k)

Paid parental time off

Flexible work options

Job summary

Cambia Health Solutions is seeking a Director of Clinical Operations and Medical Policy to lead clinical pharmacy services and strategic initiatives across multiple lines of business. This hybrid role requires guiding a team, managing budgets, and aligning with regulatory requirements to improve affordability and access to care.

The role emphasizes oversight of formulary development, medication policy, and utilization management while collaborating with internal departments and external partners

Qualifications

• Licensed pharmacist in state of practice.
• Minimum of five years of management or professional business experience in a managed health care system or related field.

Responsibilities

• Lead and direct clinical pharmacy services aligning with strategic goals.
• Oversee formulary, policy, prior authorization, and utilization management activities.
• Direct governance committees (P&T, MPG) and Medicare/QHP formularies.
• Collaborate with internal teams and external vendors to optimize programs.
• Ensure quality improvement through evidence-based evaluation methods.

Skills

Clinical pharmacy

Healthcare economics

Leadership

Communication skills

Education

PharmD or PharmBachelors

Residency or advanced degree

Job description

Cambia Health Solutions is seeking a Director of Clinical Operations and Medical Policy to lead clinical pharmacy services and strategic initiatives across multiple lines of business. This hybrid role requires guiding a team, managing budgets, and aligning with regulatory requirements to improve affordability and access to care.

The role emphasizes oversight of formulary development, medication policy, and utilization management while collaborating with internal departments and external partners