Director, Pharmacy Part B & Specialty Drugs

Alignment 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.

Job Responsibilities: 

• Lead 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 and 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 compliance with CMS requirements. 

• 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 Responsibilities:   

Oversees assigned staff. Responsibilities include: recruiting, selecting, orienting, and training employees; assigning workload; planning, monitoring, and appraising job results; and coaching, counseling, and performance management. 

 

Job Requirements: 

Experience: