VP, Chief Pharmacy Officer

Summary of Position

• Lead and transform Emblem Health's Pharmacy Solutions division to align with corporate goals and strategies for Emblem's ~2 million covered lives and ~$2 Billion in annual pharmacy spend.
• Lead the strategic direction for the enterprise's pharmacy business including implementing products, developing benefit designs, formulary and utilization management composition and pharmacy rebate negotiations across traditional, specialty, and medical pharmacy.
• Drive cross segment/department collaborations to be flexible and innovative in order to reach the concurrent goals of lower cost, increased access and improved quality outcomes for members and customers.
• Develop and improve pharmacy market competitive positioning and brand.
• Oversee the administration of the Pharmacy Program for EmblemHealth and PBM clients. Direct complete pharmaceutical, clinical/non-clinical, specialty pharmacy, and medical pharmacy services for the optimization of patient care, while containing cost. Serve as a relationship owner with Senior Management, clients, and vendors.
• Develop methods within Pharmacy to support the enterprise's clinical effectiveness capability which is designed to enhance our Value Based arrangements with provider led organizations as well as all health care delivery vendor and delegated relationships.
• Oversee and lead the advancement of pharmacy digital capabilities with a strong emphasis leveraging advanced analytics to optimize clinical outcomes, enhance operational efficiency, and inform strategic initiatives across the pharmacy enterprise.
• Oversee pharmacy data infrastructure and interoperability, ensuring pharmacy systems integrate with EHRs, claims, and care management platforms to drive actionable insights.
• Responsible for the administration of the Pharmacy Program for EmblemHealth and its affiliates and PBM clients. Oversee Pharmacy vendors (PBM, Medical Rebate Aggregator, Medical Pharmacy Drug Management Vendor,
• Medication Therapy Management (MTM) vendor, STARS vendors, etc.) including contract negotiations, contract compliance and regulatory compliance. This includes leading the Delegated Vendor Oversight Committee for the contracted Pharmacy Benefits Manager.
• Guide performance management team on audit readiness and response strategy for internal and external pharmacy-related audits, including oversight of delegated entities and CMS Program Audits.
• Provide leadership to staff and guide policy for pharmacy decision making processes and assessment of new internally developed programs as well as those developed externally through strategic partnerships. Ensure that programs comply with approved medical policy, and assess the effectiveness of each policy.
• Drive solutions in the pharmacy segment for Medicare, Commercial, and City of New York Product Owners. Act as a liaison to Actuary, Finance, MedEcon, Analytics, Case Management, Quality, Appeals, Medical Directors, and other departments. Support other departments in implementing cross-departmental and organizational changes. Mentor, train and elevate staff across departments to gain internal and external efficiencies.
• Develop and lead pharmacy strategy for sales and brokers for Commercial ASO, Fully Insured, Unions, and EGWP clients.
• Own Pharmacy Profit and Loss (P&L) responsibilities. Develop and manage pharmacy department budget. Responsible for creation, execution, and measurement of Pharmacy Trend Management initiatives.
• Responsible for Pharmacy Quality Improvement Initiatives including Medicare STAR Measure performance, HEDIS pharmacy measure performance, etc.

Principal Accountabilities

Leadership Expectations :

• Clinical & Operational Excellence. Leads enterprise-wide initiatives in logistics, operations, clinical and safety pharmacy programs. Develops and executes an enterprise-wide pharmacy strategy, including new services and partnerships.
• Strategic Thinking. Adapts to changes in the marketplace. Identifies short and long-term functional goals and strategies. Leads change efforts in redefining how to serve members and customers.
• Organizational Development. Creates and implements organization structure and develops and communicates roles/accountabilities. Identifies, develops, and engages functional talent. Identifies workforce gaps and develops talent to fill gaps. Holds Leaders and Directors accountable for developing others and managing performance. Identifies key talent/high potential and celebrates their success to further the capabilities and talent of the organization.
• Transparent Communication. Constantly develops and communicates business strategy with functional leaders; ensures employees understand how what they do links to strategy. Frequently cascades information up and down the organization. Models transparency with dashboard/metrics. Clearly and effectively communicates.
• Continuous Improvement/Innovation/Growth. Sets stretch goals that improve performance. Takes measured risks and develops contingency plans, when needed. Develops new ways of getting work done that supports innovation efforts. Proactively works to improve processes. Promotes and rewards efforts to make the work environment open to new ideas and thinking. Continuously enhances and improves own contribution. Drives growth for the organization for the pharmacy business.
• Accountability/Decision Making. Hold self and Leaders/Directors accountable for achieving results. Identifies and removes obstacles to getting things done. Makes decisions in timely manner. Displays ability to make difficult decisions.
• Financial Acumen. Successfully manages product P&Ls and department budgets.
• Serve in the following key functions to align Rx operations with Enterprise strategy and operations:
  
  
  
  • Chair of Pharmacy Operations Committee, leading the design, execution, and optimization of pharmacy operations, ensuring alignment with enterprise goals related to cost, quality, service delivery, and regulatory compliance.
  • Co-chair of Pharmacy and Therapeutics committee with Chief Medical Officer, providing strategic and clinical oversight of formulary development, ensuring evidence-based, cost-effective medication use aligned with medical policy and quality standards.
  • Provide executive-level leadership to assess pharmacy performance metrics and align departmental goals with organizational priorities.
  • Liaison with key leadership stakeholders such as VP Med Econ, VP Utilization Management, VP Analytics, CMO, and CFO to align pharmacy strategy with organizational goals, support cost containment and quality improvement initiatives, and ensure integrated decision-making across clinical, operational, and financial domains.
  
  
  
  

Deliverables :

• Makes significant contributions towards EmblemHealth's short and long term business initiatives which include Operating Income, Administrative Expenses, Medicare & Medicaid ratings, and Net Promoter Score performance.
• Identifies, hires, & trains staff members, developing them into strong leaders and creating high-performing, self-directed teams. Effectively plans for succession planning ensuring talent pipeline.
• Acts as change agent to drive and effect organizational change ensuring key deliverables are met.