Director, Clinical Strategy – RPh

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🐻 Alaska, Hawaii, +11 more states – Remote

🐻 Alaska – Remote 🌺 Hawaii – Remote 🦞 Maine – Remote 🗻 New Hampshire – Remote 🌶️ New Mexico – Remote 🌾 North Dakota – Remote 🎸 Mississippi – Remote ⚓ Rhode Island – Remote 🌴 South Carolina – Remote 🗿 South Dakota – Remote ⚔️ Virginia – Remote ⛰️ West Virginia – Remote 🦬 Wyoming – Remote

💵 $152.1k - $190.1k / year

⏰ Full Time

🔴 Lead

👨‍⚕️ Medical Director

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Navitus Health Solutions

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 2003

⚕️ Healthcare Insurance

💊 Pharmaceuticals

🤝 B2B

Healthcare Insurance • Pharmaceuticals • B2B

Navitus Health Solutions is a pharmacy benefit manager (PBM) that provides transparent, people-centered pharmacy benefit solutions to health plans, employers, government programs and other plan sponsors. The company operates a 100% pass-through, cost-plus model that emphasizes lowering medication costs, managing formularies, specialty drug management (including a cost-plus specialty pharmacy), claims adjudication, pharmacy network management, and member enablement and support services. Navitus positions itself as a fiduciary partner focused on affordability, compliance, clinical quality and improving health outcomes through tailored PBM services and digital health integrations.

📋 Description

• Design, structure, and develop long-term evolution of enterprise formulary and utilization management strategy. • Accountable for the fiscal management of the department, including forecasting, budget development, ongoing variance monitoring, and trending. • Serve as the authority on formulary strategy decisions, incorporating clinical evidence, market dynamics, and financial considerations. • Provide clinical leadership in governance forums. • Develop and lead clinical and formulary strategies aligned to organizational growth, client needs, and industry trends. • Monitor emerging drug pipeline and therapeutic trends to proactively shape formulary positioning and strategy. • Lead clinical strategy input for new business pursuits and client retention efforts. • Foster cross-functional and inter-professional work teams to drive results in support of the strategic plan of the organization. • Ensure formulary and clinical strategies align with regulatory requirements, accreditation standards, and internal policies. • Design and oversee clinical criteria for prior authorizations, step therapy, and quantity limits to ensure appropriate medication use. • Maintain accountability for clinical integrity and appropriateness of decision-making. • Provide leadership, training, and supervision to team members.

🎯 Requirements

• Bachelor’s degree in pharmacy or PharmD degree required. • Current, unrestricted licensure as a Registered Pharmacist in the state of residence, or the ability to gain reciprocity within 4 months. • 8+ years of experience in PBM, managed care, or clinical pharmacy leadership required. • 5+ years of experience leading multiple teams or functions with both clinical and business impact required. • Participate in, adhere to, and support compliance program objectives.

🏖️ Benefits

• Top of the industry benefits for Health, Dental, and Vision insurance • 20 days paid time off • 4 weeks paid parental leave • 9 paid holidays • 401K company match of up to 5% - No vesting requirement • Adoption Assistance Program • Flexible Spending Account • Educational Assistance Plan and Professional Membership assistance • Referral Bonus Program – up to $750!