At St. Luke’s, we pride ourselves on fostering a workplace culture that values diversity, promotes collaboration, and prioritizes employee well-being. Our commitment to excellence in patient care extends to creating an environment where our team can thrive both personally and professionally. With opportunities for growth, competitive benefits, and a supportive community of colleagues, St. Luke’s is truly a great place to work.
This Pharmacy Director will manage Medicare and Government Programs and play a critical role in the strategic and operational oversight of the Medicare Advantage Prescription Drug (MAPD) product. This position is accountable for Medicare Part D regulatory compliance, formulary and benefit administration, PBM oversight, CMS bid submissions, and audit readiness. The Director serves as a subject matter expert in Medicare Part B and D, maintains current knowledge of evolving CMS regulations including Inflation Reduction Act requirements, and proactively monitors pharmaceutical pipeline and payer industry trends to inform benefit strategy and risk mitigation.
What You Can Expect:
Oversee compliance with Medicare Part D requirements, including formulary and benefit administration, transition programs, pharmacy network implementation, MTM/Quality programs, and CMS regulatory audits. - Lead pharmacy-related components of the annual Medicare Part D bid submission, including review and validation of formulary, utilization management, and benefit files.
Partner with Medical Directors to evaluate and update health plan treatment protocols and formulary strategy related to Part B medications.
Provide CMS Part D audit support and ensure operational readiness across assigned areas.
Collaborate with Marketing, Compliance, Member Services, Product, and external vendors to develop compliant communications, training materials, and formulary publications related to the Medicare Advantage Part D Plan.
Implement and operationalize Inflation Reduction Act requirements in coordination with PBM partners and CMS programs.
Monitor pharmaceutical pipeline developments, utilization patterns, and payer industry trends to identify high-impact Medicare drugs.
Manage Medicare Advantage Part D PBM-managed pharmacy operations including formulary administration, opioid safety edits, pharmacy benefits, transition programs, prescriber enrollment requirements, and pharmacy network operations.
Ensure Medicare Advantage Part D Annual Enrollment Period and January 1 readiness and support cross-functional training.
Serve as the clinical and regulatory pharmacy subject matter expert for the Medicare Advantage Part D Plan.
Review and ensure timely completion of Prior Authorizations, Step Therapy, and appeal requests for Medicare Part B medications.
Performs other duties and responsibilities as assigned.
Qualifications:
Degree from an accredited pharmacy program.
Five (5) years' relevant experience.
MBA or Pharmacy Residency in lieu of two (2) years' experience.
Licensed Pharmacist within state of Idaho (must be obtained by date of hire).
St. Luke’s has been committed to the health and well-being of the people we serve since our founding in 1902. As our communities’ needs have evolved, so have we — expanding how we care for our friends and neighbors.Today, St. Luke’s is more than a hospital. We’re an integrated health system delivering care in our hospitals and clinics, connecting communities to a network of exceptional providers through St. Luke’s Health Partners and funding care through St. Luke’s Health Plan.
