Director, Pharmacy Clinical Operations - Emory Health Plan

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Director of Pharmacy, Clinical Operations - Emory Health Plan is responsible for driving clinical excellence, evidence‑based medication management, and stewardship of pharmacy spend across enterprise plan's membership.

• Leads medication use evaluations (MUEs), prepares clinical materials for the Pharmacy & Therapeutics (P&T) Committee, develops strategies that improve quality outcomes, and serves as a liaison to Emory physicians, service lines, and clinical leaders.
• Supports both clinical and financial performance by identifying opportunities for optimized utilization, implementing evidence‑based initiatives, and advancing EHP's integrated care model.
• Leads Medication Use Evaluations (MUEs) across high‑cost, high‑impact therapeutic categories (e.g., specialty, chronic disease, oncology, immunology).
• Identifies medication‑related trends, quality gaps, and opportunities for improved clinical management.
• Develops clinical strategies that enhance outcomes, reduce unwarranted variation, and promote safe, cost‑effective prescribing.
• Evaluates new therapies, guidelines, and pipeline agents to inform proactive benefit and policy decisions.
• Prepares, reviews, and presents clinical materials for the Pharmacy & Therapeutics Committee, including drug monographs, comparative evidence reviews, formulary recommendations, and safety updates.
• Ensures clinical recommendations reflect best available evidence, Emory clinical pathway alignment, and financial stewardship considerations.
• Maintains documentation, committee records, and formulary reference materials.
• Partners with UM teams to design and refine prior authorization criteria, step therapy pathways, and clinical edits.
• Monitors utilization patterns, adherence trends, prescribing behaviors, and opportunities for quality improvement.
• Leads development of clinical care pathways, disease state strategies, and population health pharmacy programs (e.g., cardiometabolic, immunology, rare disease).
• Supports HEDIS, STARs, and internal quality initiatives through pharmacy‑focused interventions.
• Serves as the primary pharmacy liaison with Emory physicians, clinical service lines, ambulatory care teams, and population health leaders.
• Collaboratively develops evidence‑based approaches to improve prescribing, optimize specialty drug use, and support value‑based care initiatives.
• Provides clinical guidance to EHP leadership, including interpretation of therapeutic evidence, quality metrics, and medication policy impacts.
• Identifies opportunities to reduce avoidable pharmacy and medical spend while maintaining or improving clinical outcomes.
• Conducts cost‑effectiveness analyses, total cost of care reviews, and ROI assessments for pharmacy programs.
• Collaborates with analytics and finance partners to track specialty drug trend, high‑cost member impact, and budget performance.
• Supports integration of medical + pharmacy benefit strategies to improve care alignment and financial sustainability.
• Partners closely with PBM teams, Emory Specialty Pharmacy, ambulatory pharmacy operations, care management, and population health teams. Supports implementation of new benefit designs, formulary changes, and clinical programs.
• Contributes to EHP governance committees, physician advisory groups, and enterprise clinical initiatives.

• Doctor of Pharmacy (Pharm
  
  D) from an accredited School of Pharmacy.
• At least 5 years of clinical pharmacy, managed care, or health system experience and 5 years of leadership experience.
• Strong knowledge of drug therapy, formulary management, evidence evaluation, and population health principles.
• Experience preparing drug monographs, MUEs, or P&T materials.
• Ability to engage effectively with physicians, clinical leaders, and multidisciplinary teams.
• Strong analytical and communication skills.

• Completion of PGY1 residency…