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Executive Director Health Plan Operations Jobs (NOW HIRING)

AHG MASTER

Executive Director

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... plan, ensuring that the facility meets its financial and operational goals. This role requires a ... Master's degree in healthcare/business administration preferred. * Three to five years of proven ...

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Executive Director Health Plan Operations information

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$11K

$152.9K

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How much do executive director health plan operations jobs pay per year?

As of Sep 13, 2026, the average yearly pay for executive director health plan operations in the United States is $152,881.00, according to ZipRecruiter salary data. Most workers in this role earn between $96,500.00 and $187,000.00 per year, depending on experience, location, and employer.

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Infographic showing various Executive Director Health Plan Operations job openings in the United States as of September 2026, with employment types broken down into 2% As Needed, 76% Full Time, 17% Part Time, and 5% Contract. Highlights an 91% Physical, 1% Hybrid, and 8% Remote job distribution, with an average salary of $152,881 per year, or $73.5 per hour.

Pharmacy Director - Health Plan

Columbia, MD • On-site

MedStar Health
Health Care and Social Assistance • 10K+ employees
Learn more about MedStar Healthexternal

$348K/yr

Full-time

Re-posted 8 days ago

Medstar Health rating

7.8

Company rating: 7.8 out of 10

Based on 242 frontline employees who took The Breakroom Quiz

Job description

About the Job
General Summary of Position
The Director of Pharmacy provides strategic leadership and operational oversight for pharmacy benefit management formulary strategy medication utilization and pharmacy quality initiatives across the health plan. This role is responsible for ensuring safe cost effective and evidence-based medication use while supporting regulatory compliance value-based care initiatives and population health goals. The Director collaborates with clinical leadership pharmacy benefit managers (PBMs) providers and health plan operations to optimize pharmacy programs that improve patient outcomes and manage total cost of care.
Primary Duties and Responsibilities
  • Develop and implement the health plan pharmacy strategy aligned with organizational goals and population health priorities.
  • Lead formulary management pharmacy policy development and medication utilization management programs.
  • Provide oversight of pharmacy benefit design and cost containment initiatives.
  • Manage relationships with pharmacy benefit managers (PBMs) and specialty pharmacy vendors.
  • Oversee formulary development rebate programs contract performance and pharmacy network management.
  • Monitor pharmacy benefit performance metrics and implement improvement initiatives.
  • Direct programs such as: Prior authorization step therapy medication therapy management (MTM) specialty pharmacy management
  • Ensure clinical programs are evidence based and aligned with national guidelines and regulatory requirements.
  • Ensure compliance with CMS NCQA state regulations and accreditation standards related to pharmacy services.
  • Support Medicaid pharmacy program requirements as applicable.
  • Lead pharmacy-related quality initiatives and performance reporting.
  • Use pharmacy claims and clinical data to: Identify utilization trends manage drug spend support value-based care models.
  • Develop dashboards and reporting to monitor pharmacy performance indicators.
  • Collaborate with physicians pharmacists and care management teams to optimize medication use.
  • Serve as a subject matter expert on pharmacy policy and medication management.
  • Support provider education on formulary updates and pharmacy programs.
  • Recruit develop and supervise pharmacy and clinical staff.
  • Foster a culture of collaboration accountability and continuous improvement.

Minimal Qualifications
Education
  • Bachelor's degree Graduate training in an accredited College of Pharmacy. required
  • Doctoral degree Doctor of Pharmacy (PharmD) required
  • Advanced degree (MBA MPH MHA) preferred

Experience
  • 8-10 years Pharmacy leadership experience required
  • Significant experience in health plan pharmacy PBM operations or managed care pharmacy required
  • Experience with Medicare Part D Medicaid or commercial pharmacy benefits preferred Certifications required

Licenses and Certifications
  • PharmD - licensed pharmacist in the District of Columbia and Maryland or eligibility for reciprocity upon hire (required)
  • BCPA-Board Certified Patient Advocate Board Certification (e.g. BCPS BCACP) preferred
  • PTCB - Pharmacy Technician Certification Board Board Certification (e.g. BCPS BCACP) preferred
  • PHARMACOTH - Board Certified Pharmacotherapy Specialist Board Certification (e.g. BCPS BCACP) preferred

Knowledge Skills and Abilities
  • Managed care pharmacy expertise
  • Pharmacy benefit design and formulary management
  • Regulatory and accreditation knowledge (CMS NCQA)
  • Financial and utilization analytics
  • Strategic leadership and change management
  • Stakeholder collaboration and communication
  • Pharmacy cost trend and total drug spend
  • Medication adherence and quality metrics
  • Formulary compliance and utilization management outcomes
  • PBM contract performance
  • Regulatory and accreditation compliance

This position has a hiring range of
USD $161,158.00 - USD $348,296.00 /Yr.

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About Medstar Health

Sourced by ZipRecruiter

MedStar Health is dedicated to providing the highest quality care for people in Maryland and the Washington, D.C., region, while advancing the practice of medicine through education, innovation, and research. Our team of 32,000 includes physicians, nurses, residents, fellows, and many other clinical and non-clinical associates working in a variety of settings across our health system, including 10 hospitals and more than 300 community-based locations, the largest home health provider in the region, and highly respected institutes dedicated to research and innovation. As the medical education and clinical partner of Georgetown University for more than 20 years, MedStar Health is dedicated not only to teaching the next generation of doctors, but also to the continuing education, professional development, and personal fulfillment of our whole team. Together, we use the best of our minds and the best of our hearts to serve our patients, those who care for them, and our communities. It's how we treat people.

Industry

Health care and social assistance

Company size

10,000+ Employees

Headquarters location

Columbia, MD, US

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