Pharmacy Director - St. Luke's Health Plan-152133

Description & Requirements

At St. Luke’s, we pride ourselves on fostering a workplace culture that values diversity, promotes collaboration, and prioritizes employee well-being. Our commitment to excellence in patient care extends to creating an environment where our team can thrive both personally and professionally. With opportunities for growth, competitive benefits, and a supportive community of colleagues, St. Luke’s is truly a great place to work.

This Pharmacy Director will manage Medicare and Government Programs and play a critical role in the strategic and operational oversight of the Medicare Advantage Prescription Drug (MAPD) product. This position is accountable for Medicare Part D regulatory compliance, formulary and benefit administration, PBM oversight, CMS bid submissions, and audit readiness. The Director serves as a subject matter expert in Medicare Part B and D, maintains current knowledge of evolving CMS regulations including Inflation Reduction Act requirements, and proactively monitors pharmaceutical pipeline and payer industry trends to inform benefit strategy and risk mitigation.

What You Can Expect

• Oversee compliance with Medicare Part D requirements, including formulary and benefit administration, transition programs, pharmacy network implementation, MTM/Quality programs, and CMS regulatory audits. Lead pharmacy-related components of the annual Medicare Part D bid submission, including review and validation of formulary, utilization management, and benefit files.
• Partner with Medical Directors to evaluate and update health plan treatment protocols and formulary strategy related to Part B medications.
• Provide CMS Part D audit support and ensure operational readiness across assigned areas.
• Collaborate with Marketing, Compliance, Member Services, Product, and external vendors to develop compliant communications, training materials, and formulary publications related to the Medicare Advantage Part D Plan.
• Implement and operationalize Inflation Reduction Act requirements in coordination with PBM partners and CMS programs.
• Monitor pharmaceutical pipeline developments, utilization patterns, and payer industry trends to identify high-impact Medicare drugs.
• Manage Medicare Advantage Part D PBM-managed pharmacy operations including formulary administration, opioid safety edits, pharmacy benefits, transition programs, prescriber enrollment requirements, and pharmacy network operations.
• Ensure Medicare Advantage Part D Annual Enrollment Period and January 1 readiness and support cross‑functional training.
• Serve as the clinical and regulatory pharmacy subject matter expert for the Medicare Advantage Part D Plan.
• Review and ensure timely completion of Prior Authorizations, Step Therapy, and appeal requests for Medicare Part B medications.
• Perform other duties and responsibilities as assigned.

Qualifications

• Degree from an accredited pharmacy program.
• Five (5) years' relevant experience.
• MBA or Pharmacy Residency in lieu of two (2) years' experience.
• Licensed Pharmacist within state of Idaho (must be obtained by date of hire).

Preferred Qualifications

• Health Plan/PBM/Part D experience.

What's In It For You

At St. Luke’s, caring for people in the communities we serve is our mission – and this includes our own SLHS team. We offer a robust benefits package to support our teams both professionally and personally. In addition to a competitive salary and retirement plans, we ensure our team feels supported in their benefits beyond the typical medical, dental, and vision offerings. We care about you and have fantastic financial and physical wellness options, such as: on‑site massages, on‑site counseling via our Employee Assistance Program, access to the Personify Health Wellness tool, as well as other formal training and career development offerings to ensure you are meeting your career goals.

St. Luke’s is an equal opportunity employer and does not discriminate against any person on the basis of race, religion, color, gender, gender identity, sexual orientation, age, national origin, disability, veteran status, or any other status or condition protected by law.

• Please note: this posting is not reflective of all job duties and responsibilities and is intended to provide an overview to job seekers.

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