VP Pharmacy Operations - JHP

Job Details

Serve as the primary point of contact and operational lead responsible for managing the procurement, administration, and ongoing performance of Pharmacy Services for members of JHP and HPP Oversee contractual, financial , operational, clinical and quality aspects related to pharmacy benefits, ensuring alignment with business objectives and regulatory compliance. Provide strategic and operational oversight to optimize pharmacy benefit management, support financial stewardship, and deliver value to members and stakeholders. Drive and implement integration across the Jefferson enterprise. Responsibility for Pharmacy-related quality measures.
Provide hands-on support and operational oversight to the Pharmacy Benefit Manager (PBM) to ensure seamless service delivery, adherence to contract terms, and continuous improvement in pharmacy benefit operations.

Job Description

Essential Functions

• Interacts with co-workers, visitors, and other staff consistent with the values of Jefferson.
• Maintain vigilant oversight of pharmacy benefit operations to ensure efficient, compliant, and cost-effective service delivery.

• Develop, implement, and monitor strategic, operational, and tactical business plans aligned with organizational goals for pharmacy benefits.
• Lead procurement, negotiation, execution, and management of contracts for Pharmacy Services and pharmaceutical manufacturers supporting Jefferson Health Plans.
• Serve as a key operational liaison to the Pharmacy Benefit Manager (PBM), supporting day-to-day PBM functions, monitoring service levels, and collaborating to resolve issues impacting member experience and benefit administration.
• Oversee Pharmacy Benefit Manager (PBM) contract performance, ensuring compliance with Department of Human Services  (DHS), Centers for Medicare and Medicaid Services (CMS), Pennsylvania Insurance Department (PID)and other regulatory requirements.
• Monitor pharmacy-related financial performance and benefit utilization, providing regular updates and actionable insights to Senior Management and Presidents’ staff.
• Ensure all pharmacy operations comply with Federal, State, and local regulations, including fraud, abuse, and compliance oversight in collaboration with Corporate Compliance.
• Coordinate the submission of required federal, state, and internal reporting on pharmacy benefit operations.
• Collaborate cross-functionally with claims processing, risk management, clinical teams, and the PBM to optimize pharmaceutical claims accuracy, data integrity, and benefit delivery.
• Lead continuous improvement initiatives to enhance operational efficiency, member satisfaction, and business outcomes within pharmacy benefit management.
• Develop and manage budgets related to pharmacy services and benefits, optimizing resources and cost management.
• Recruit, develop, motivate, and retain high-performing managers and team members focused on pharmacy benefit operations.
• Facilitate communication and data exchange with external partners, risk system owners, and internal stakeholders to support business objectives.
• Support adherence to quality standards such as National Committee for Quality Assurance (NCQA) and Health Employer Data Information Set (HEDIS) in pharmacy benefit programs.
• Perform other duties as assigned to support the overall success of the pharmacy benefit operations.
• Find and create strategic opportunities for pharmacy benefit synergy across the Enterprise.

Competencies (Knowledge, Skills, and Abilities Required):

• In-depth knowledge of clinical, operational, and financial aspects of pharmacy benefit management and healthcare delivery.
• Proven expertise in supporting and overseeing Pharmacy Benefit Manager (PBM) operations, including contract compliance, service monitoring, and issue resolution.
• Strong experience in procurement, contract negotiation, and vendor relationship management, particularly with pharmaceutical manufacturers and PBMs.
• Excellent leadership skills with the ability to recruit, develop, and retain high-performing teams.
• Advanced organizational, project management, and process improvement capabilities.
• Strong analytical skills with the ability to interpret complex data to inform strategic and operational decisions.
• Excellent communication and interpersonal skills to collaborate effectively across internal teams and with external partners.
• Working knowledge of relevant software applications, including Microsoft Excel, Access, Word, and other data management tools.
• Ability to maintain strict compliance with Federal and State regulations, including DHS, CMS and PID guidelines, and corporate compliance standards.
• Ability to transform complex d