Job Details

Serve as the primary point of contact and operational lead responsible for managing the procurement, administration, and ongoing performance of Pharmacy Services for members of JHP and HPP Oversee contractual, financial , operational, clinical and quality aspects related to pharmacy benefits, ensuring alignment with business objectives and regulatory compliance. Provide strategic and operational oversight to optimize pharmacy benefit management, support financial stewardship, and deliver value to members and stakeholders. Drive and implement integration across the Jefferson enterprise. Responsibility for Pharmacy-related quality measures.
Provide hands-on support and operational oversight to the Pharmacy Benefit Manager (PBM) to ensure seamless service delivery, adherence to contract terms, and continuous improvement in pharmacy benefit operations.

Job Description

Essential Functions

• Interacts with co-workers, visitors, and other staff consistent with the values of Jefferson.
• Maintain vigilant oversight of pharmacy benefit operations to ensure efficient, compliant, and cost-effective service delivery.

• Develop, implement, and monitor strategic, operational, and tactical business plans aligned with organizational goals for pharmacy benefits.
• Lead procurement, negotiation, execution, and management of contracts for Pharmacy Services and pharmaceutical manufacturers supporting Jefferson Health Plans.
• Serve as a key operational liaison to the Pharmacy Benefit Manager (PBM), supporting day-to-day PBM functions, monitoring service levels, and collaborating to resolve issues impacting member experience and benefit administration.
• Oversee Pharmacy Benefit Manager (PBM) contract performance, ensuring compliance with Department of Human Services  (DHS), Centers for Medicare and Medicaid Services (CMS), Pennsylvania Insurance Department (PID)and other regulatory requirements.
• Monitor pharmacy-related financial performance and benefit utilization, providing regular updates and actionable insights to Senior Management and Presidents’ staff.
• Ensure all pharmacy operations comply with Federal, State, and local regulations, including fraud, abuse, and compliance oversight in collaboration with Corporate Compliance.
• Coordinate the submission of required federal, state, and internal reporting on pharmacy benefit operations.
• Collaborate cross-functionally with claims processing, risk management, clinical teams, and the PBM to optimize pharmaceutical claims accuracy, data integrity, and benefit delivery.
• Lead continuous improvement initiatives to enhance operational efficiency, member satisfaction, and business outcomes within pharmacy benefit management.
• Develop and manage budgets related to pharmacy services and benefits, optimizing resources and cost management.
• Recruit, develop, motivate, and retain high-performing managers and team members focused on pharmacy benefit operations.
• Facilitate communication and data exchange with external partners, risk system owners, and internal stakeholders to support business objectives.
• Support adherence to quality standards such as National Committee for Quality Assurance (NCQA) and Health Employer Data Information Set (HEDIS) in pharmacy benefit programs.
• Perform other duties as assigned to support the overall success of the pharmacy benefit operations.
• Find and create strategic opportunities for pharmacy benefit synergy across the Enterprise.

Competencies (Knowledge, Skills, and Abilities Required):

• In-depth knowledge of clinical, operational, and financial aspects of pharmacy benefit management and healthcare delivery.
• Proven expertise in supporting and overseeing Pharmacy Benefit Manager (PBM) operations, including contract compliance, service monitoring, and issue resolution.
• Strong experience in procurement, contract negotiation, and vendor relationship management, particularly with pharmaceutical manufacturers and PBMs.
• Excellent leadership skills with the ability to recruit, develop, and retain high-performing teams.
• Advanced organizational, project management, and process improvement capabilities.
• Strong analytical skills with the ability to interpret complex data to inform strategic and operational decisions.
• Excellent communication and interpersonal skills to collaborate effectively across internal teams and with external partners.
• Working knowledge of relevant software applications, including Microsoft Excel, Access, Word, and other data management tools.
• Ability to maintain strict compliance with Federal and State regulations, including DHS, CMS and PID guidelines, and corporate compliance standards.
• Ability to transform complex data into clear, data-driven recommendations that shape strategic and operational initiatives.

Understanding market trends, identifying growth opportunities (e.g., specialty pharmacy, direct-to-patient models), and developing effective business strategies.

Minimum Education and Experience Requirements:

Education:

PharmD degree preferred, MBA or advanced degree.  A. A minimum 10 years of progressive leadership experience in pharmacy operations and managed care settings

AND

Experience:

• At least five years’ experience working directly with or supporting Pharmacy Benefit Manager (PBM) operations and pharmacy benefit administration.
• Minimum five years of management experience overseeing pharmacy benefit programs, procurement, or related operational functions.
• Demonstrated experience in contract negotiation and vendor management, especially related to pharmacy services and pharmaceutical manufacturers.
• Strong background in regulatory compliance related to pharmacy benefits, including familiarity with Department of Human Services  (DHS),Centers for Medicare and Medicaid Services (CMS) and Pennsylvania Insurance Department (PID)requirements

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Work Shift

Workday Day (United States of America)

Worker Sub Type

Regular

Employee Entity

Health Partners Plans, Inc.

Primary Location Address

1101 Market, Philadelphia, Pennsylvania, United States of America

Nationally ranked, Jefferson, which is principally located in the greater Philadelphia region, Lehigh Valley and Northeastern Pennsylvania and southern New Jersey, is reimagining health care and higher education to create unparalleled value. Jefferson is more than 65,000 people strong, dedicated to providing the highest-quality, compassionate clinical care for patients; making our communities healthier and stronger; preparing tomorrow's professional leaders for 21st-century careers; and creating new knowledge through basic/programmatic, clinical and applied research. Thomas Jefferson University, home of Sidney Kimmel Medical College, Jefferson College of Nursing, and the Kanbar College of Design, Engineering and Commerce, dates back to 1824 and today comprises 10 colleges and three schools offering 200+ undergraduate and graduate programs to more than 8,300 students. Jefferson Health, nationally ranked as one of the top 15 not-for-profit health care systems in the country and the largest provider in the Philadelphia and Lehigh Valley areas, serves patients through millions of encounters each year at 32 hospitals campuses and more than 700 outpatient and urgent care locations throughout the region. Jefferson Health Plans is a not-for-profit managed health care organization providing a broad range of health coverage options in Pennsylvania and New Jersey for more than 35 years.    

Jefferson is committed to providing equal educa­tional and employment opportunities for all persons without regard to age, race, color, religion, creed, sexual orientation, gender, gender identity, marital status, pregnancy, national origin, ancestry, citizenship, military status, veteran status, handicap or disability or any other protected group or status. 

Benefits

Jefferson offers a comprehensive package of benefits for full-time and part-time colleagues, including medical (including prescription), supplemental insurance, dental, vision, life and AD&D insurance, short- and long-term disability, flexible spending accounts, retirement plans, tuition assistance, as well as voluntary benefits, which provide colleagues with access to group rates on insurance and discounts. Colleagues have access to tuition discounts at Thomas Jefferson University after one year of full time service or two years of part time service. All colleagues, including those who work less than part-time (including per diem colleagues, adjunct faculty, and Jeff Temps), have access to medical (including prescription) insurance.

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