The Government Specialty Pharmacy Director provides strategic leadership and oversight for the specialty pharmacy benefit serving a large federal member population. It is also responsible for leading the overall administration, operational delivery, regulatory compliance, and program performance.
This leader serves as the enterprise owner of the specialty pharmacy benefit strategy for the Federal Employee Program, partnering with executive stakeholders, federal program leaders, and vendor partners to ensure optimal clinical outcomes, member experience, and program performance.
Success in this role requires strong account management skills, a deep understanding of specialty pharmacy benefits, and the ability to manage PBM and specialty pharmacy partners.
- Account Leadership and Strategic Stakeholder Management.
- Serve as the executive leader and strategic owner for the Federal Employee Program’s specialty pharmacy benefit, ensuring alignment with federal program objectives, clinical priorities, and organizational strategy.
- Build and maintain trusted partnerships with federal program leadership, senior internal stakeholders, and vendor partners, serving as the primary subject matter expert and strategic advisor for specialty pharmacy benefit performance.
- Lead executive program reviews and strategic discussions, presenting insights on program performance, emerging risks, and opportunities for improvement.
- Provide leadership across clinical, operational, financial, analytics, and PBM teams to ensure coordinated delivery of specialty pharmacy services and program initiatives.
- Manage high-priority escalations and complex issues while ensuring resolution strategies align with long-term program performance and member experience goals.
Specialty Benefit Administration.
- Provide strategic oversight and governance of the specialty pharmacy benefit, ensuring benefit design, utilization management policies, and specialty program operations align with federal program requirements and evolving clinical standards.
- Guide the planning, implementation, and continuous improvement of specialty pharmacy benefit programs to support member access, clinical outcomes, and operational efficiency.
- Monitor program performance through key operational, clinical, and service metrics, identifying opportunities to strengthen program effectiveness and member experience.
- Partner with clinical, and operational teams to support annual benefit planning, policy updates, and specialty program enhancements.
Federal Program Oversight & Compliance.
- Ensure the specialty pharmacy program operates in full compliance with federal regulations, contractual obligations, and program governance standards.
- Maintain readiness for federal audits and regulatory reviews by overseeing documentation, internal controls, and cross-functional program coordination.
- Partner with legal, compliance, and regulatory teams to interpret policy changes and implement program adjustments necessary to maintain compliance and operational integrity.
Vendor Governance & PBM Partnership Management.
- Provide strategic oversight of PBM and specialty pharmacy vendor relationships, ensuring service delivery aligns with contractual expectations, program objectives, and member experience standards.
- Establish and monitor vendor performance metrics, service-level agreements, and governance frameworks to drive accountability and continuous improvement.
- Lead executive-level vendor discussions to address performance issues, implement process improvements, and ensure operational alignment with federal program requirements.
Implementation Leadership.
- Lead cross-functional teams responsible for implementing specialty pharmacy benefit updates, program enhancements, and regulatory changes impacting the Federal Employee Program.
- Provide oversight of implementation planning, operational readiness, and stakeholder communication to ensure successful program execution.
- Ensure implementation efforts align with enterprise priorities, program governance standards, and federal program timelines.
Analytics, Insights and Program Performance.
- Leverage specialty pharmacy claims data, utilization trends, and operational metrics to evaluate program performance and identify strategic improvement opportunities.
- Develop and present executive-level reporting, dashboards, and program insights to support informed decision-making by senior leadership and federal program stakeholders.
- Translate complex pharmacy and operational data into actionable recommendations to improve financial performance, operational efficiency, and member outcomes.
Complex Issue Resolution and Operational Excellence.
- Lead resolution of high-impact operational issues and complex benefit challenges, ensuring timely resolution while addressing root causes.
- Conduct structured root cause analysis and continuous improvement initiatives to strengthen program processes and prevent recurrence of operational issues.
- Partner across PBM, clinical, and operational teams to ensure consistent, high-quality delivery of specialty pharmacy services and continuous improvement of program performance.
The posting range for this position is:
$141,980.00-$204,225.37
Qualifications:
Education
- Required Bachelor's Degree Degree in Pharmacy, Health Care Administration, Business or related field; or equivalent experience
- Preferred Master's Degree MBA or PharmD preferred
Experience
- Required 15+ Years Experience in account management, pharmacy benefit administration, PBM operations, specialty pharmacy, or federal health care program oversight
Knowledge Skills and Abilities
- Strong understanding of specialty benefit design, utilization management, clinical programs, and PBM operations.
- Experience supporting, managing, or administering Federal programs (e.g., Federal Employee Program, TRICARE, VA, DoD, or other federally regulated healthcare benefits). Direct experience with the Federal Employee Program (FEP), OPM requirements, or similar federal benefit environments preferred.
- Familiarity with specialty pharmacy workflows, prior authorization programs, and limited-distribution networks preferred.
- Knowledge of federal regulatory requirements, audit standards, and healthcare program compliance preferred.
- Demonstrated ability to manage large, complex accounts with multiple stakeholders.
- Excellent communication, presentation, and executive-facing engagement skills.
- Ability to interpret and translate pharmacy data into actionable insights.
- Experience leading cross-functional projects or program implementations.
#LI-Remote
This is the lowest to highest salary we, in good faith, believe we would pay for this role at the time of this posting. We may ultimately pay more or less than the hiring range and this hiring range may also be modified in the future. A candidate’s position within the hiring range may be based on several factors including, but not limited to, specific competencies, relevant education, qualifications, certifications, relevant experience, skills, seniority, performance, shift, travel requirements, and business or organizational needs. This job is also eligible for annual bonus incentive pay.
We offer a comprehensive package of benefits including paid time off, 11 holidays, medical/dental/vision insurance, generous 401(k) matching, lifestyle spending account and many other benefits to eligible employees.
Note: No amount of pay is considered to be wages or compensation until such amount is earned, vested, and determinable. The amount and availability of any bonus, commission, or any other form of compensation that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.