# Director Clinical Operations and Medical Policy

Hiring organization: [Cambia Health Solutions](https://career.thegoodapps.co/organizations/cambia-health-solutions)

Canonical page: https://career.thegoodapps.co/jobs/ad3e839d-fecd-4186-987e-1709a6b6a8f0

Listed on Cambia Health Solutions's own careers site. Applications go to them directly.

- Employment type: full time
- Seniority: Director
- Salary: 166992 – 242700 USD per year

## Summary

Lead clinical pharmacy operations and medication policy strategy for a large health plan, overseeing formulary development, prior authorization, and utilization management across multiple benefit types while managing a team and nearly $2 billion in annual drug spending. Suited to an experienced pharmacist leader with managed care expertise who wants to drive medication policy and clinical innovation in a mission-driven organization.

_Our summary, not Cambia Health Solutions's wording._

## Skills named

CPT Coding, Utilization Management

## Required

- PharmD or Bachelor's degree in Pharmacy
- Licensed pharmacist in state of practice
- Minimum five years of management experience in managed care, medical group, hospital, or related healthcare delivery organization
- Strong clinical pharmacy background with therapy skills and knowledge
- Knowledge of health care economics, financing, and industry dynamics
- Ability to manage professional relationships in managed care settings
- Excellent verbal and written communication skills
- Strong business analytical and project management skills
- Knowledge of Health Plan benefit design structures and Medicare regulations
- Knowledge of pharmaceutical products including orals, injectables, infusions, and chemotherapy
- Knowledge of healthcare coding and payment systems

## Nice to have

- Residency certificate or advanced degree in health care administration, economics, public health, pharmacy administration, or finance
- Compliance, legislative, or regulatory activities experience
- Knowledge of state and federal pharmacy practice and healthcare regulation laws such as DOLI, PPACA, and HIPAA
- Ability to leverage AI tools to drive efficiency and innovation

Apply on Cambia Health Solutions's site: https://cambiahealth.wd504.myworkdayjobs.com/en-US/External/job/Fargo-ND/Director-Clinical-Operations-and-Medical-Policy_R-6760