Director, Pharmacy Part B & Specialty Drugs

Director, Pharmacy Part B & Specialty DrugsAlignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together.The Director, Pharmacy Part B and Specialty Drugs is responsible for overseeing and optimizing Medicare Advantage Part B drug utilization and specialty drug initiatives. This leader ensures cost-effective, compliant, and high-quality delivery of specialty and physician-administered medications, while aligning formulary strategies, utilization management, and provider engagement with the organization’s overall clinical, financial, and Stars performance goals.ResponsibilitiesLead specialty drug program design, execution, and monitoring across Part B and Part D lines within the Medicare Advantage business.Serve as the subject matter expert on specialty drug trends, pipeline, and management strategies.Develop and implement utilization management programs to optimize cost and member outcomes.Lead clinical policy development and pipeline monitoring for emerging high-cost therapies.Oversee specialty pharmacy programs, contracts, and vendor performance.Partner with finance and actuarial teams to forecast drug trends and manage Part B and Part D pharmacy P&L.Track and improve performance metrics including drug spend, rebate performance, utilization trends, and Star quality measures.Drive performance improvement initiatives to reduce unnecessary variation and ensure CMS compliance.Lead the review and analysis of medical benefit drug claims, focusing on cost drivers, outliers, and opportunities for clinical intervention.Collaborate with medical directors, care management teams, and providers to ensure evidence-based prescribing, site-of-care optimization, and effective care coordination.Provide clinical guidance on prior authorization, step therapy, and medical necessity criteria for Part B drugs and specialty drugs.Support formulary management by partnering with Pharmacy team, PBM/vendor, and Pharmacy & Therapeutics (P&T) Committee.Ensure all programs are fully compliant with CMS regulations, NCQA standards, and internal policy requirements.Maintain readiness for CMS audits and other regulatory reviews.Build strong relationships with providers, infusion centers, and specialty pharmacies to support appropriate utilization and access.Collaborate with contracting team to negotiate cost-effective agreements with vendors and providers.Other duties and projects not listed above.Supervisory ResponsibilitiesOversees assigned staff. Responsibilities include: recruiting, selecting, orienting, and training employees; assigning workload; planning, monitoring, and appraising job results; and coaching, counseling, and performance management.ExperienceRequired: 7–10+ years of leadership experience in managed care pharmacy, with direct experience in Medicare Advantage Part B and specialty drug management.EducationRequired: PharmD or advanced degree in pharmacy required. Preferred: MBA, MPH, or health policy degree.LicensureRequired: Active pharmacist license.Specialized SkillsDemonstrated expertise in specialty drug utilization management, formulary strategy, and regulatory compliance.Strong understanding of CMS regulations governing both Part B and Part D.Strong financial acumen with direct experience managing pharmacy budgets and performance outcomes.Proven leadership, communication, and cross-functional collaboration skills.Essential Physical FunctionsThe physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.While performing the duties of this job, the employee is regularly required to talk or hear. The employee is regularly required to stand, walk, sit, use hands to finger, handle or feel objects, tools, or controls; and reach with hands and arms.The employee frequently lifts and/or moves up to 10 pounds. Specific vision abilities required include close vision and the ability to adjust focus.Pay Range: $149,882.00 - $224,823.00Pay range may be based on a number of factors including market location, education, responsibilities, experience, etc.Alignment Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, age, protected veteran status, gender identity, or sexual orientation.DISCLAIMER: Please beware of recruitment phishing scams affecting Alignment Health and other employers where individuals receive fraudulent employment-related offers in exchange for money or other sensitive personal information. Alignment Health and its subsidiaries will never ask you for a credit card, or payment as part of consideration for employment. If you feel that you have been the victim of a scam, please report it to the Federal Trade Commission at If you would like to verify the legitimacy of an email from Alignment Health’s talent acquisition team, please email . #J-18808-Ljbffr

Created: 2025-10-06