Responsible for the strategic direction, growth, and profit and loss for the Health Plan pharmacy annual spend as well as the outsourced Pharmacy Benefits Manager (PBM) relationship. Leads a multi-disciplinary team and partners with clinical leadership to drive an integrated pharmacy and medical management model that will continue to reshape the care delivery system and improve health of the SWHP members.
Provides strategic direction and guidance on all pharmacy initiatives. Lead the development and implementation of annual and multi-year strategic planning processes for the pharmacy operations function. Ensure regulatory compliance by leading and developing medication safety and compliance programs.
Deliver and exceed profitable growth objectives for the Pharmacy Business. This includes revenue, expense management, rebates and total net earnings.
Oversee the Pharmacy Benefit Manager (PBM) relationship; ensure market competitive PBM and Specialty Pharmacy results while focusing on developing long-term value for customers through clinical pharmacy program innovation. Influence members and provider desired behaviors through incentives, formulary, and benefit design.
Oversee and directs the development, implementation, and administration of pharmacy programs in alignment with System strategies. Develops and maintains cost effective pharmacy programs utilizing formulary management to increase medication compliance and ensure appropriate member care. Leads the development of new models of pharmacy and medication integration.
Lead the assessment of current pharmacy benefits in collaboration with internal departments; provide expertise to internal departments and external stakeholders on benefit design. Anticipate and discuss the impact of large-scale trends, and properly position or reposition the pharmacy business appropriately. Develop and assess metrics to evaluate program performance. Identify and implement industry best practices to optimize performance.
Ensure the integration of the pharmacy line of business in the Health Plan's care models and member engagement strategies. Develop a consistent approach to supporting sales and retention of pharmacy benefits customers, working collaboratively with Health Plan business partners.
Analyze clinical individual and population data, drug program data, and drug therapy data. Integrate the clinical, administrative, and business policies and procedures of the pharmacy department in order to facilitate patient-centered care for members through effective collaboration with internal departments.
Develop and ensure adherence to goals and deadlines for the Pharmacy department.
Oversee the work of the pharmacy staff. Provide strategic leadership and direction to management including performance management oversight and employee development.
Knowledge, Skills and Abilities
Demonstrated knowledge of pharmacy benefit management, and the broader ecosystem of managed care, including prescription drugs, pharmacy benefits design, utilization review, cost containment strategies, formulary management and emerging technology.
Strong financial acumen and experience leading large P&Ls equivalent in size to the Health Plan's pharmacy business.
Strong business acumen with ability to evaluate, tailor and develop integrated pharmacy programs.
A highly articulate communicator and compelling leader who can communicate the Health Plan's vision and value proposition to internal and external constituents.
Experience and understanding of how to work within a complex business model to deliver a total value proposition, and experience navigating through matrix organizational structures.
Strong strategic thinking; able to develop a clear and compelling vision and strategy and translate into goals and measurable results.
Ability to motivate, lead and inspire a diverse group to a common goal/solution with multiple stakeholders and work collaboratively to develop solutions.
A purpose-driven self-starter who is comfortable managing through ambiguity; possesses creativity and drive to solve complex problems.
Knowledge of state and federal laws as applicable to the health insurance industry and PBM industry.
The ability to attract, recruit and retain top talent, motivate the team, delegate effectively, celebrate diversity within the team, and management performance; widely viewed as a strong developer of others.
Bachelors degree in Pharmacy or related field.Doctorate of Pharmacy, preferred.
Ten or more years pharmacy experience preferred,with a minimum of 8 years of management/team leadership experience.
Baylor Scott & White Health (BSWH) is the largest not-for-profit health care system in Texas and one of the largest in the United States. With a commitment to and a track record of innovation, collaboration, integrity and compassion for the patient, BSWH stands to be one of the nation’s exemplary health care organizations. Our mission is to serve all people by providing personalized health and wellness through exemplary care, education and research as a Christian ministry of healing. Joining our team is not just accepting a job, it’s accepting a calling!