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GEHA (Government Employees Health Association, Inc., pronounced G.E.H.A.) is a nonprofit member association that provides medical and dental benefits to more than two million federal employees and retirees, military retirees and their families. We celebrate diversity and are committed to creating an inclusive environment for all employees.

GEHA has one mission: To empower federal workers to be healthy and well.

Offering one of the largest medical and dental benefit provider networks available to federal employees in the United States, GEHA empowers health and wellness by meeting its members where they are, when they need care. We serve our members with products they value and a personalized customer experience, sustained by a nimble and efficient organization.

The Director of Pharmacy Operations & PBM Management will guide and improve our Federal Employee Health Benefit (FEHB) and Postal Services Health Benefits (PSHB) environment as market, member, and regulatory needs change.

We are looking for a strategic Health Plan Pharmacy leader to manage delegated PBM contract oversight (inclusive of utilization and formulary management), oversee clinical initiatives and programs (Medication Therapy Management, HEDIS/Quality) and monitor disputed claims processes. This leader will also partner closely with the VP of Pharmacy and other enterprise leadership to drive business outcomes and meet regulatory, affordability, clinical quality, and corporate goals.

In this role, your leadership will:

Evolve our pharmacy management model by partnering with stakeholders and vendors to better outline the total cost of care capabilities.

Collaborate with internal and external partners to achieve business goals aligned with short-term and long-term strategies.

Empower others to support G.E.H.A in improving member experience and growth.

SKILLS

Pharmacy Strategy & Operations Oversight

+ Set strategic direction for program development, achieving appropriate outcomes and business performance measures related to access, affordability, quality, and experience, including business performance, clinical pharmacy operations, PBM and vendor oversight, utilization management, and formulary.

+ Ensure operational excellence of the pharmacy benefit program at G.E.H.A.

+ Partner with internal stakeholders regarding clinical programming, product development, benefit design, and vendor negotiations.

+ Manage department staff (clinical and non-clinical) performance, development, and succession planning. Foster departmental development and ensure high performance to support the organization’s mission and strategic goals.

+ Lead cross-functional initiatives with internal and external partners to improve pharmacy program efficiency and innovation.

PBM Contract Oversight & Performance Management

+ Day to day management of the commercial PBM and Medicare Part D / EGWP administrator relationships for the FEHB and PSHB lines of business.

+ Analyze and track PBM performance against key performance indicators, ensuring alignment with corporate goals.

+ Oversee changes in pharmacy benefits implemented by the PBM, ensuring compliance and strategic alignment.

Regulatory Compliance & Accreditation

+ The role ensures compliance with all relevant contracts, accreditation criteria, and federal regulations, including those from OPM for Federal Employee Health Benefits (FEHB) and Postal Services Health Benefits (PSHB) along with those for CMS for Medicare Part D / Employer Group Waiver Plan (EGWP) through our administrator.

+ Monitor and interpret the CMS and OPM landscape, implement OPM Carrier Letters, develop policies and procedures to maintain compliance, and partner with the GEHA Compliance teams to provide documentation and notification of compliance initiatives.

Financial & Clinical Program Leadership

+ Lead the development and execution of financial strategies for drug pricing, discounts, rebates, and reimbursement to optimize plan cost savings.

+ Oversee department budgetary aspects of the pharmacy department, ensuring fiscal accountability and cost-effectiveness.

+ Collaborate with teams across the clinical division to implement clinical programs that enhance quality, patient safety, and medication adherence.

Requirements

+ Licensed pharmacist (PharmD) required.

+ 10+ years of experience in managed care pharmacy, pharmacy benefit management, or the PBM industry.

+ 5-7+ years of experience managing PBM relationships and contracts.

+ 5+ years in leadership roles with a focus on operational and strategic oversight.

+ Expertise in formulary management, utilization management, and regulatory compliance in both commercial and government programs.

Preferred Qualifications

+ An advanced degree (e.g., Master’s in Healthcare Administration or Business Administration) is preferred.

+ Knowledge of FEHB federal benefits and Medicare Part D / EGWP regulations.

+ Strong problem-solving and decision-making skills.

+ Proficiency in data analysis, financial modeling, and performance metrics.

+ Ability to manage multiple initiatives and meet deadlines in a demanding environment.

+ Excellent verbal, written, and collaboration skills.

+ Experience with accreditation standards and regulatory compliance frameworks.

+ Demonstrated ability to lead cross-functional teams and drive organizational change.

Work-at-home requirements

+ Must have the ability to provide a non-cellular High Speed Internet Service such as Fiber, DSL, or cable Modems for a home office.

+ A minimum standard speed for optimal performance of 30x5 (30mpbs download x 5mpbs upload) is required.

+ Latency (ping) response time lower than 80 ms

+ Hotspots, satellite and wireless internet service is NOT allowed for this role.

+ A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

How we value you

+ Competitive pay/salary ranges

+ Incentive plan

+ Health/Vision/Dental benefits effective day one

+ 401(k) retirement plan: company match – dollar for dollar up to 4% employee contribution (pretax or Roth options) plus a 6% annual company contribution

+ Robust employee well-being program

+ Paid Time Off

+ Personal Community Enrichment Time

+ Company-provided Basic Life and AD&D

+ Company-provided Short-Term & Long-Term Disability

+ Tuition Assistance Program

Please note that the salary information is a general guideline only. GEHA considers factors such as (but not limited to) scope and responsibilities of the position, candidate’s work experience, education/training, key skills, internal peer equity, as well as, market and business considerations when extending an offer.

The annual base salary range for this position is $169,320 - $238,680 USD.

GEHA is an Equal Opportunity Employer, which means we will not discriminate against any individual based on sex, race, color, national origin, disability, religion, age, military status, genetic information, veteran status, pregnancy, marital status, gender identity, and sexual orientation, as well as all other characteristics and qualities protected by federal, state, or local law. GEHA will not discriminate against employees or applicants because they have inquired about, discussed, or disclosed their compensation or the compensation of another employee or applicant. We are committed to creating an inclusive environment for all employees. Our diversity drives innovation deepens connections and strengthens our organization.

GEHA is headquartered in Lee's Summit, Missouri, in the Kansas City area. We recognize the importance of balance and flexibility and offer hybrid and work-from-home options for many of our roles.

Please note: Due to recent fraudulent activity in the job market, if you receive correspondence from someone at GEHA, we recommend you review the following facts to help verify if someone is truly a GEHA employee before sharing any personal information.

+ All email addresses of GEHA employees will end with our domain,@ geha.com . Any other domain is not verified and is illegitimate. **Please double check the spelling as well** .

+ We will never extend a job offer without having at least one live video call.

+ We will never ask you for or provide you with any money, personal or banking information during the interview process or before signing an offer letter.

Please report any suspicious messages to [email protected] so that we can help reduce this fraudulent activity.

GEHA (Government Employees Health Association, Inc., pronounced G.E.H.A.) is a nonprofit member association that provides medical and dental benefits to more than two million federal employees and retirees, military retirees and their families. Offering one of the largest medical and dental benefit provider networks available to federal employees in the United States, GEHA empowers health and wellness by meeting its members where they are, when they need care. Among our core values is embracing diversity and inclusion, where we thrive by creating an environment in which each of our employees feels a sense of belonging, can engage their full potential and focus on enriching our people, culture and community.

Your FUTURE is here with us –COME GROW WITH GEHA!

Benefits start on day one! Great 401(k) match! Tuition assistance programs! Professional development! Advancement opportunities!

For additional information, please visit GEHA Careers. (https://www.geha.com/careers)