Director, Pharmacy - San Francisco Health Plan

At San Francisco Health Plan (SFHP), we have a leadership position that will impact the quality of healthcare for our most vulnerable population in San Francisco.

Reporting to the Senior Medical Director, the Director of Pharmacy is responsible for coordinating and monitoring all aspects of the pharmacy program for Health Plan members, ensuring the Pharmacy department’s overall compliance, operational and financial performance, and customer experience. Your responsibilities include oversight of the daily pharmacy program operations, oversight of the contracted Pharmacy Benefits Manager (PBM), oversight of the specialty pharmacy vendor, oversight of any groups delegated to provide a pharmacy service and providing clinical integration of the pharmacy program with our internal disease and case management programs. This position ensures that the SFHP Pharmacy Team runs efficiently, develops accurate and actionable reporting, works well with the other departments and key external stakeholders, and meets performance expectations.

The Director ensures achievement of organizational and department goals through vigorous monitoring of program and department metrics. You are responsible for regular analysis of pharmacy data, and for researching literature to identify quality and cost containment opportunities, in collaboration with the clinical pharmacy staff and Medical Directors. You will collaborate with key stakeholders to understand their challenges and facilitate improvement to software applications. You are a member of the Directors’ Team. Members of the Directors’ Team are responsible for the execution of SFHP’s strategic projects.

SFHP is in the process of developing a Medicare D-SNP program going to market 1/1/2026. This role is responsible for the pharmacy related activities leading up to that, including pharmacy benefit design, as well as compliant Part D pharmacy operations to CMS requirements.

SFHP is proud to offer a hybrid work environment. As such, this role will be required to be onsite, in office a minimum of 4 days per month.

Salary range: $221,000 - $243,000

WHAT YOU WILL DO

• Monitor, evaluate and present all Plan pharmacy data including monthly reporting of trends for drug utilization and drug costs. Recommends possible strategies to promote cost-effective therapy and quality of care for SFHP members.
• Ensure that Pharmacy policies and practices are compliant with NCQA accreditation standards.
• Oversee and manage all aspects of contracts with SFHP’s PBM and consultants including the selection and contracting, as necessary.
• Develop and manage pharmacy program budget based on the organization’s goals and industry trend drivers.
• Coordinate and participate in the P&T committee meeting. In conjunction with internal staff and our PBM, make recommendations to the P&T committee regarding new medications, formulary placement of medications, and prior authorization criteria (if applicable).
• Revises, maintains and publishes the SFHP Drug Formulary and prior authorization criteria in coordination with the Pharmacy Services Staff.
• Review pharmacy prior authorization requests for medical necessity, using best practices and quality standards.
• Prepare pharmacy data for use in provider-specific reports and targeted academic detailing as needed.
• Coordinate with product and actuary to develop business and pricing strategy, providing thought leadership on product, and for the development and submission of compliant Part D bids to CMS.
• Coordinate with other functions in support of business transactions and decisions including pricing/bids, formulary analysis, regulatory change impact analysis, forecasting, and risk management.
• Identify, recommend, monitor, and track effective Rx cost analysis, product and risk alignment with financial performance targets, through coordination with internal functions supporting the business, such as actuarial, finance and product.
• Lead development and implementation of business unit performance measures and enhance processes that drive accountability measurements throughout the organization and of the PBM.
• Oversee and ensure compliance with all applicable reporting requirements and regulations to minimize compliance risk and exposure.
• Collaborate and respond to inquiries from external parties, such as state agencies, regulators, or auditors, as needed.
• Supervise daily operations of prior authorization procedures.
• Bring significant issues to the attention of the Senior Medical Director Health Services with recommendations for solutions. Oversee the implementation of solutions.
• Prepare the pharmacy program for review, survey and accreditation processes by external monitoring agencies, such as DHCS, DMHC, and NCQA.
• Write, review, and seek approval for policies and procedures, ensuring that both the departmental and organizational needs are met.
• Identify, develop, and oversee the educational needs of the staff, with the goal of optimizing skills and knowledge of emerging approaches to quality/process improvement.
• The Director of Pharmacy also serves as the Residency Program Director for the PGY1 Managed Care Pharmacy Program and for the leadership of the Advanced Pharmacy Practice Experience (APPE) managed care pharmacy student rotation. The Director is responsible for the oversight of both the Residency and pharmacy student programs, including requirements related to staffing, planning, and the clinical and administrative aspects of the rotation(s).
• Supervise Clinical Pharmacists, Clinical Coordinators, PGY1 Managed Care Pharmacy resident, and APPE managed care pharmacy student (when applicable)
• Actively participant with the Directors Team.
• Represent SFHP on pharmacy-related forums with the Department of Healthcare Services.
• Oversee collaborations and relationships between ITS, Operations and Vendors.
• Provide vision, strategic, and long-term solutions in key applications related to Health Services.
• Oversee HEDIS measure performance and reporting.
• Promote and further SFHP’s culture and mission by fostering an environment where all staff are recognized, understood, appreciated and embrace inclusion and belonging.

WHAT YOU WILL BRING

• Registered Pharmacist (Doctor of Pharmacy Preferred) with a California State license required; current CA Pharmacy license to practice without restriction.
• MBA a plus.
• Minimum of 3 years of experience with formulary management in a health care delivery setting (or equivalent).
• 5+ years of leadership experience, coaching, mentoring and managing talented and engaged staff.
• Experience with CMS Medicare pharmacy requirements and with formulary development and compliant bid submissions.
• Experience in an HMO or experience in managed care setting, a plus.
• Knowledge of, and experience with, state and federal insurance programs, preferred.

WHAT WE OFFER
A competitive and robust compensation package, including:

• Health Benefits:
  • Medical: You’ll have a choice of medical plans, including options from Kaiser and Blue Shield of California. Employee-only coverage in the HMO plans is currently available at no cost and dependent coverage is heavily subsidized by SFHP.
  • Dental: You’ll have a choice of a basic dental plan or an enhanced dental plan which includes orthodontic coverage.
  • Vision: Employee vision care coverage is available through Vision Service Plan (VSP).
• Retirement – Employer-matched CalPERS Pension and 401(a) plans, 457 Plan
• Time off – 23 days of Paid Time Off (PTO) and 13 paid holidays
• Professional development: Opportunities for tuition reimbursement, professional license/membership.
• An opportunity to work in a vibrant atmosphere with the most amazingly talented people who are shaping the future of healthcare!
• The chance to make a difference in the lives of many San Francisco residents!

ABOUT SFHP
Established in 1997, San Francisco Health Plan (SFHP) is an award winning, managed care health plan whose mission is to provide affordable health care coverage to the underserved low and moderate-income residents in San Francisco county. SFHP is chosen by eight out of every ten San Francisco Medi-Cal managed care enrollees and its 175,000+ members have access to a full spectrum of medical services including preventive care, specialty care, hospitalization, prescription drugs, and family planning services. SFHP was designed by and for the residents it serves and takes great pride in its ability to accommodate a diverse population that includes young adults, seniors, and people with disabilities.

San Francisco Health Plan is proud to be an equal opportunity employer. We are committed to a work environment that supports, inspires, and respects all individuals and in which our people processes are applied without discrimination on the basis of race, color, religion, sex, sexual orientation, gender identity, marital status, age, disability, national or ethnic origin, military service status, citizenship, or other protected characteristics.

Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.

San Francisco Health Plan is an E-Verify participating employer.

Hiring priority will be given to candidates residing in the San Francisco Bay Area and California.