Director, Pharmacy Operations Strategy – Integration

🔥 8 minutes ago

🤠 Texas – Remote

🤠 Texas – Remote

💵 $162.5k - $213.2k / year

⏰ Full Time

🔴 Lead

⚙️ Operations

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Oscar Health

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 2012

⚕️ Healthcare Insurance

🏥 Healthcare

💰 $355M Post-IPO Debt - Oscar Health on 2025-09

Healthcare Insurance • Healthcare

Oscar Health is a technology-driven health insurance company that provides individual, family, and small-group health plans in multiple U. S. states. Oscar combines traditional insurance underwriting with digital-first services — a consumer-facing app, 24/7 virtual urgent care, prescription delivery (including $3 meds in many plans), and dedicated Care Teams — and also operates Oscar Primary Care in some markets. The company emphasizes accessible, affordable, high-quality care and uses AI to improve member experience and care delivery. Insurance policies are underwritten by Oscar's state insurance subsidiaries and the company offers both HMO and other plan types across its markets.

📋 Description

• Set the pharmacy operational excellence strategy, operating rhythm, and execution model • Lead high-priority pharmacy operational transformation initiatives from strategy through execution, including opportunity definition, roadmap development, operational readiness, launch planning, and sustained adoption • Serve as a primary operational partner across internal and external teams, translating pharmacy and PBM opportunities, member and provider needs, and frontline insights into priorities, decisions, and measurable outcomes • Interpret applicable PBM, pharmacy benefit, managed care, and healthcare regulatory requirements • Maintain deep understanding of the pharmacy and healthcare ecosystem, including payer economics, benefit and network dynamics, claims processes, formulary operations, prior authorization workflows, utilization patterns, vendor handoffs, affordability, and experience drivers • Partner with internal stakeholders and external vendors on implementation plans, business reviews, strategic meetings, issue escalation, performance monitoring, and operational integration • Coordinate across Clinical, Pharmacy Operations, Product, Engineering, Finance, Actuarial, Concierge, Compliance, and vendor partners • Diagnose process, data, technology, and vendor friction points and design end-to-end solutions • Improve member and provider experience across pharmacy journeys • Lead governance and executive reporting for pharmacy operational excellence initiatives • Identify and manage implementation risks, dependencies, decisions, and change-management needs • Build operating playbooks, process standards, controls, and best practices for a scalable PBM operating model • Resolve complex problems and determine courses of action for technology-enabled process improvement and operational transformation • Support capacity planning, budget management, business-case development, and value realization measurement • Ensure workflows, vendor capabilities, and program execution meet regulatory, compliance, quality, and contractual requirements • Comply with applicable laws and regulations • Perform other duties as assigned

🎯 Requirements

• 10+ years of experience in healthcare, business operations, strategy and operations, product operations, or program leadership • 7+ years of Managed Care, PBM, pharmacy operations, clinical operations, or related healthcare payer experience • 5+ years leading large-scale, cross-functional strategy, operational transformation, or implementation initiatives from opportunity definition through launch and adoption • 5+ years partnering directly with cross-functional business, Product, Engineering, vendor, or operations teams to set priorities, define requirements, influence solutions, and deliver business outcomes • Experience interpreting regulatory, compliance, operational, or contractual business needs and translating them into actionable requirements • Experience with strategic planning, roadmapping, business analysis, operational readiness, change management, and executable cross-functional plans • Experience translating complex operational data and performance information into executive-level insights, recommendations, and governance materials • Experience managing budgets, capacity models, business cases, or financial performance for operational or transformation initiatives • MBA, MPH, or Master's degree in Business Administration or a related field preferred • Experience with management consulting, internal strategy and operations, process engineering, Lean, or Six Sigma • Experience with PBM implementation, pharmacy benefit administration, claims adjudication, formulary operations, prior authorization, rebate/formulary systems, or healthcare data feeds • Experience working in matrixed teams through enterprise transformation, implementation, or operational excellence work

🏖️ Benefits

• Employee benefits • Unlimited vacation program • Company equity grants • Annual performance bonuses • Medical benefits • Dental benefits • Vision benefits • 11 paid holidays • Paid sick time • Paid parental leave • 401(k) plan participation • Life insurance • Disability insurance • Paid wellness time • Wellness reimbursements

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