Director of Pharmacy Operations

The Director, Pharmacy Operations has responsibility and accountability for all operational functions in support of Medica's pharmacy business, including vendor oversight for delegated functions. Operational functions include, but are not limited to, Part D Administration, Eligibility, Benefit set-up, Claims and all associated tasks and processes. The incumbent is responsible for accurate and timely transactional processing and ensuring process performance is meeting regulatory and business expectations. The Director, Pharmacy Operations works collaboratively to establish, maintain and/or adjust processes to meet Federal, State and business requirements. The role serves as the primary point of contact for business segment staff on all matters related to pharmacy operations and compliance.

Key Accountabilities

• Functional Operational Oversight




• Manages development, implementation and maintenance of pharmacy operational and business processes that support the efficient and compliant administration of Medica pharmacy offerings
• Aligns processes and reporting to proactively identify negative trends and potential issues and implement corrective actions as necessary
• Identifies work efficiencies through documenting, simplifying and/or automating processes where possible
• Monitors CMS and DHS guidance and other applicable federal and state regulations and ensures corresponding process changes are identified and implemented in a timely manner




• Vendor Management and Performance




• Implements vendor operational oversight strategies and supporting tools
• Engages in creation, implementation and/or adjustment of reporting metrics
• Serves as an escalation point for issues relating to performance, regulatory adherence and disparities in processes
• Collaborates with Compliance and other Medica departments to ensure adherence to federal and state regulations and business requirements
• Ensures vendor operational performance consistently meets contractual expectations and regulatory requirements




• People Development




• Identifies and solves for staffing gaps and resource needs
• Provides clear communication of accountabilities and priorities to leadership and staff with regular review of performance
• Deploys training and tools to ensure leadership and staff are operating at required skill levels
• Regularly reviews department policies and procedures to ensure alignment of work and desired results
• Conducts one-to-one and staff meetings consistently, to align priorities, workflow and communication
• Actively participates in enterprise-wide leadership development programs
• Active pursues self-professional development

Minimum Qualifications

• Bachelor's degree in business or related field
• 10 years of experience beyond degree

Skill and Abilities

• Pharmacy operations experience in a PBM, health plan, or related industry
• Experience with Medicare Part D and regulatory adherence in the health care industry and/or health plan operations
• Previous management or leadership experience
• Demonstrated ability to use data and complex information to make fact-based decisions
• Experience in vendor relationship management
• Project management experience
• Proven history of working cross-functional with both internal and external stakeholders
• Experience presenting to and engaging with senior leadership
• Understanding of technical, operational and administrative processes associated with operational functions
• Must be able to influence, negotiate, and resolve conflicts to reach consensus around common goals.

This position is a hub-based role which requires onsite presence. To be eligible for consideration, candidates must reside within a commuting distance to one of the following office locations: Minnetonka, MN, Madison, WI, or Omaha, NE. Onsite frequency is determined by business need as decided by leadership and may be up to 2-3 days a week.

The full salary range for this position is $127,800 - $219,000. Annual salary range placement will depend on a variety of factors including, but not limited to, education, work experience, applicable certifications and/or licensure, the position's scope and responsibility, internal pay equity and external market salary data. In addition to base compensation, this position may be eligible for incentive plan compensation in addition to base salary. Medica offers a generous total rewards package that includes competitive medical, dental, vision, PTO, Holidays, paid volunteer time off, 401K contributions, caregiver services and many other benefits to support our employees.

The compensation and benefits information is provided as of the date of this posting. Medica's compensation and benefits are subject to change at any time, with or without notice, subject to applicable law.

Medica's commitment to diversity, equity and inclusion (DEI) includes unifying our workforce through learning and development, recruitment and retention. We consistently communicate the importance of DEI, celebrate achievements, and seek out community partnerships and diverse suppliers that are representative of everyone in our community. We are developing sustainable programs and investing time, talent and resources to ensure that we are living our values. We are an Equal Opportunity/Affirmative Action employer, where all qualified candidates receive consideration for employment indiscriminate of race, religion, ethnicity, national origin, citizenship, gender, gender identity, sexual orientation, age, veteran status, disability, genetic information, or any other protected characteristic.