Director, Pharmacy Part B and Specialty Drugs

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September 19

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Alignment Health

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Healthcare Insurance • Insurance • Healthcare

Alignment Health is dedicated to providing comprehensive care for Medicare members, emphasizing the needs of seniors, the chronically ill, and those who are frail. With a mission to transform senior healthcare, Alignment Health leverages a tailored care model and advanced technology to deliver high-quality, low-cost healthcare services. Their 24/7 concierge care team collaborates with trusted local providers to ensure that every member receives personalized care, reflecting the company's commitment to treating all members as valued family members.

501 - 1000 employees

Founded 2013

⚕️ Healthcare Insurance

💰 $135M Series C on 2020-03

📋 Description

• Overseeing and optimizing Medicare Advantage Part B drug utilization and specialty drug initiatives • Lead specialty drug program design, execution, and monitoring across Part B and Part D lines within the Medicare Advantage business • Serve as the subject matter expert on specialty drug trends, pipeline, and management strategies • Develop and implement utilization management and programs to optimize cost and member outcomes • Lead clinical policy development and pipeline monitoring for emerging high-cost therapies • Oversee specialty pharmacy programs, contracts, and vendor performance • Partner with finance and actuarial teams to forecast drug trends and manage Part B and Part D pharmacy P&L • Track and improve performance metrics including drug spend , rebate performance, utilization trends, and Star quality measures • Drive performance improvement initiatives to reduce unnecessary variation and ensure compliance with CMS requirements • Lead the review and analysis of medical benefit drug claims, focusing on cost drivers, outliers, and opportunities for clinical intervention • Collaborate with medical directors, care management teams, and providers to ensure evidence-based prescribing, site-of-care optimization, and effective care coordination • Provide clinical guidance on prior authorization, step therapy, and medical necessity criteria for Part B drugs and specialty drugs • Support formulary management by partnering with Pharmacy team , PBM /vendor , and Pharmacy & Therapeutics (P&T) Committee • Ensure all programs are fully compliant with CMS regulations, NCQA standards, and internal policy requirements • Maintain readiness for CMS audits and other regulatory reviews • Build strong relationships with providers, infusion centers, and specialty pharmacies to support appropriate utilization and access • Collaborate with contracting team to negotiate cost-effective agreements with vendors and providers • Oversees assigned staff; recruiting, selecting, orienting, training, assigning workload, planning, monitoring, appraising, coaching, counseling, and performance management

🎯 Requirements

• 7–10+ years of leadership experience in managed care pharmacy, with direct experience in Medicare Advantage Part B and specialty drug management • PharmD or advanced degree in pharmacy required • Preferred: MBA, MPH, or health policy degree preferred • Demonstrated expertise in specialty drug utilization management, formulary strategy, and regulatory compliance • Strong understanding of CMS regulations governing both Part B and Part D • Strong financial acumen with direct experience managing pharmacy budgets and performance outcomes • Proven leadership, communication, and cross-functional collaboration skills • Active pharmacist license • Supervisory experience: recruiting, selecting, orienting, and training employees; assigning workload; planning, monitoring, and appraising job results; coaching, counseling, and performance management

🏖️ Benefits

• Pay Range: $149,882.00 - $224,823.00 Pay range may be based on a number of factors including market location, education, responsibilities, experience, etc. • Equal Opportunity/Affirmative Action Employer statement • Support for reporting recruitment phishing scams and contact for verification (careers@ahcusa.com)