Sr Director, Pharmacy Management

CalOptima Health Partnership; Orange (CA); Hybrid; USD 216,000 - 347,000; Full time

Job summary

A community-based healthcare organization in California seeks a Sr Director of Pharmacy Management to lead pharmacy services and drive strategic initiatives. The ideal candidate will have substantial experience in pharmacy management, healthcare regulations, and strong leadership skills to enhance member services. This role offers a competitive salary, comprehensive benefits, and is primarily on-site with some telework eligibility.

Benefits

Competitive salary

Comprehensive benefits package

PTO and work-life balance

Tuition reimbursement

Qualifications

• 7 years Medicare Part D and Medicaid experience required.
• 5 years pharmacy management experience in managed-care.
• 3 years progressive pharmacy leadership experience.

Responsibilities

• Lead pharmacy department and improve service quality.
• Develop formulary strategy and manage PBM engagement.
• Ensure compliance with healthcare regulations.

Skills

Leadership

Regulatory compliance

Pharmacy management

Communication

Education

Doctor of Pharmacy (PharmD)

Tools

Microsoft Office

Job description

Sr Director, Pharmacy Management

Join CalOptima and build healthier communities while advancing your career. CalOptima is a mission‑driven, community‑based organization dedicated to serving members with excellence and dignity. As a senior leader, you will help shape the future of healthcare through pharmacy management, regulatory compliance, and strategic innovation.

Overview

From strategic planning and leadership to operational oversight, your responsibilities will span all aspects of pharmacy services within a managed‑care organization, including Medi‑Cal, Medicare Advantage Part D, and Covered California. You will design and evaluate pharmacy benefit programs, develop formulary strategy, manage PBM engagement, and ensure compliance with CMS, DMHC, and other governing bodies.

Responsibilities

• Leadership (60%)
  • Promote a mission‑driven culture focused on member service, dignity, and accountability.
  • Direct and oversee the Pharmacy department, collaborating with leadership and staff to achieve short‑ and long‑term goals.
  • Develop and implement pharmacy business plans and strategic initiatives aligned with CalOptima’s objectives.
  • Drive quality improvements across Star Ratings, PQA measures, HEDIS outcomes, and other programs.
  • Define governance practices using KPIs to monitor service quality and drive continuous improvement.
  • Maintain operational compliance with standards, policies, and regulations; communicate changes effectively.
  • Serve as subject matter expert for the executive team and Board of Directors.
  • Recruit, coach, and retain a high‑performing pharmacy team; develop departmental policies.
  • Collaborate with the CMO on annual budgets, staffing models, succession planning, and cost projections.
  • Lead the Pharmacy and Therapeutics Committee and foster partnerships across departments and with vendors.
• Program Operations Oversight (35%)
  • Lead all pharmacy‑related operations, including formulary development, prior authorization, and utilization management for Medi‑Cal, Medicare, and Covered California.
  • Guide the Pharmacy team (clinical pharmacists, operations, analytics) toward excellence and innovation.
  • Oversee new program design and implementation for Covered California.
  • Collaborate with internal departments to optimize member outcomes and drug cost effectiveness.
  • Ensure compliance with CMS, DMHC, Covered California, and Medi‑Cal Rx regulations.
  • Oversee PBM procurement, contracting, and performance, including real‑time oversight of PBM Point‑of‑Service fulfillment.
  • Provide financial oversight, budgeting, and reporting for pharmacy benefit expenditures.
  • Develop internal performance reports and meet external regulatory reporting requirements.
  • Implement pharmacy performance standards and manage audit preparation and corrective action plans.
• Other Projects (5%) Complete additional duties and projects as assigned.

Qualifications

• Doctor of Pharmacy (PharmD) plus 7 years of Medicare Part D and Medicaid experience.
• 5 years of pharmacy management experience with commercial managed‑care products, including Covered California.
• 3 years of progressive pharmacy leadership in a health plan, PBM, or managed‑care environment.
• Demonstrated success in pharmacy benefit strategy, regulatory compliance, and PBM/vendor contract management.
• Experience with CMS audits, DHCS guidelines, and California Medicaid programs.

Desired (Additional Credentials)

• 15 years of health‑plan and pharmacy experience in Medicare Part D and Medi‑Cal.
• Residency in Managed Care or Pharmacy Practice.

Regulatory Agencies Requirements

• Current, valid, unrestricted California State Pharmacy License and PharmD.

Knowledge & Abilities

• Establish effective relationships with leadership, staff, and external contacts.
• Work independently with sound judgment; communicate clearly in writing and orally.
• Maintain a flexible schedule, including evenings and weekends.
• Organize, analyze, problem‑solve, and manage multiple projects.
• Lead multi‑program teams and external committees or coalitions.
• Proficient with Microsoft Office (Word, Outlook, Excel, PowerPoint) and job‑specific systems.

Physical Requirements

• Visual acuity for computer screens and printed materials.
• Clear speech and hearing for phone and face‑to‑face communication.
• Manual dexterity for typing, writing, standing, and reaching; flexibility for bending, crouching, walking, kneeling, and prolonged sitting.
• Ability to lift and move objects up to 10–25 lb.

Benefits & Compensation

• Competitive salary. Current hiring range: $216,737 – $346,778.
• Full‑office position (telework eligible in California only).
• Comprehensive benefits package, CalPERS pension, and retirement programs.
• Generous PTO, work‑life balance, wellness programs, tuition reimbursement, and professional development.
• Flexible scheduling and a meaningful impact on healthcare access.

Work Environment

• Indoor, sedentary, and subject to variable hours with travel as needed.
• No harmful environmental conditions at most locations.
• Moderate to loud noise levels in clinical or community settings.

EEO Statement

CalOptima Health is committed to attracting, hiring, and retaining a diverse staff… CalOptima Health is an equal opportunity employer … The full statement is retained but without tags.

Application Process

All applications will be accepted on a continuous basis until a sufficient number of qualified applicants have been received. The deadline for the first review is December 7, 2025 at 9:00 PM (PST). The recruitment may close at any time without notice after the first review date.

Contact & Application

To apply, please visit: https://jobs.caloptima.org/jobs/sr-director-pharmacy-management-505-city-parkway-west-california-united-states

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