ASSOCIATE PHARMACY DIRECTOR - 73868

Executive Service

The Division of TennCare is dedicated to providing our employees with a hybrid work environment. All TennCare positions have a combination of work from home and work in the office, which varies by position, department, and business need. You may review the specific expectations with our hiring team.

Background Check:

This position requires a criminal background check. Therefore, you may be required to provide information about your criminal history in order to be considered for this position.

Who we are and what we do:

TennCare is Tennessee's managed care Medicaid program that provides health insurance coverage to certain groups of low-income individuals such as pregnant women, children, caretaker relatives of young children, older adults, and adults with physical disabilities. TennCare provides coverage for approximately 1.7 million Tennesseans and operates with an annual budget of approximately $14 billion. It is run by the Division of TennCare with oversight and some funding from the Centers for Medicare and Medicaid Services (CMS). TennCare's mission is to improve the lives of Tennesseans by providing high-quality cost-effective care. To fulfill that purpose, we equip each employee for active participation and empower teams to communicate and worked collaboratively to improve organizational processes in order to make a difference in the lives our members. Because of the positive impact TennCare has on the lives of the most vulnerable Tennesseans, TennCare employees report that their work provides them with a sense of meaning, purpose, and accomplishment. TennCare leadership understands that employees are our most valuable resource and ensures professional and leadership development are a priority for the agency.

Job Overview:

Operationally, the TennCare Pharmacy Unit (TPU) develops, implements, and oversees pharmacy benefit policy, formulary management, pharmacy claims adjudication, and vendor oversight for the Division of TennCare. The Pharmacy Unit collaborates closely with Pharmacy Benefits Managers (PBMs), Managed Care Organizations (MCOs), healthcare providers, and other internal TennCare stakeholders to ensure accurate, timely, and clinically appropriate medication access for all TennCare members.

The TennCare Associate Pharmacy Director will serve as a policy subject matter expert, reporting directly to the Chief Pharmacy Officer (CPO) and providing ongoing support to the CPO and TennCare Pharmacy Directors. In this role, they will contribute to the development and execution of pharmacy policy initiatives in close coordination with TennCare Pharmacy Unit directors supporting clinical, operational, and ancillary workstreams. The position will also dedicate a portion of time to collaborate with Associate Medical Directors and other colleagues across the Chief Medical Office on projects that intersect with pharmacy data, clinical policy, or benefit alignment. This cross-functional engagement reflects TennCare's commitment to integrated care and coordinated policy development across the organization. The Policy Pharmacist will use clinical expertise, medical and pharmacy analytics, and regulatory understanding to enhance TennCare's pharmacy benefit delivery, ensuring compliance, fiscal responsibility, and optimal patient care outcomes.

Key Responsibilities:

1. Support and maintain accountability for TennCare pharmacy policy development and deployment.
2. Support the development, implementation, and periodic review of TennCare pharmacy coverage policies to ensure consistency with Medicaid regulations, CMS guidelines, and clinical best practices.
3. Translate clinical evidence, program data, and statutory requirements into actionable pharmacy benefit strategies.
4. Support policy changes related to prior authorization, formulary management, and medical/pharmacy claims integration.
5. Oversee development of internal documentation, provider guidance, and committee-facing materials for Drug Utilization Review (DUR), Pharmacy Advisory Committee (PAC), and other forums.
6. Assist in developing pharmacy-related portions of State Plan Amendments (SPAs), legislative analyses, and federal or audit responses.
7. Provide oversight, strategic input, and proactive collaboration with internal TennCare divisions and external stakeholders, while contributing to cross-divisional pharmacy policy alignment in support of Chief Medical Office initiatives.
8. Develop and refine provider notices, policy summaries, and FAQs to explain changes in coverage or program operations.
9. Collaborate with TennCare Pharmacy Unit leadership, external partners, and Chief Medical Office stakeholders for accurate claims processing, effective benefit design, data-driven decision-making, and integrating pharmacy strategies into multidisciplinary care and coverage.
10. Analyze pharmacy and medical claims data to identify trends, evaluate outcomes, support policy decisions, and provide input on performance measures, cost modeling, and quality benchmarks for pharmacy utilization.
11. Support pharmacy directors and Associate Medical Directors in assessing financial and clinical impacts of benefit changes, and in clinical, operational, and ancillary program management.
12. Maintain internal tracking systems, dashboards, and audit-ready documentation.
13. Integrate pharmacy considerations into multi-disciplinary efforts like MAT network design, BESMART, and RxSMART programs.
14. Participate in regular data reviews with PBMs and MCOs to address adjudication issues and coverage misalignment.
15. Foster transparency and partnership through clear, collaborative engagement with pharmacy stakeholders.
16. Promote consistent, informative communication with providers, contractors, and advocacy partners to ensure understanding of TennCare pharmacy policies, reimbursement protocols, and benefit expectations.

Minimum Qualifications:

• Doctor of Pharmacy (PharmD or equivalent)
• Licensed (or eligible to be licensed) to practice as a Pharmacist in the State of Tennessee
• 2+ years of experience in clinical pharmacy program administration which may include formulary benefit analysis, steering formulary positioning, implementing online system edits and restrictions, pharmacy benefit utilization, and performance trend monitoring.
• 2+ years of experience in clinical pharmacy which may include clinical pharmacy residency, supporting P&T committee reviews and designations, management of clinical formularies, and pharmacy benefit design, provision of clinical drug information
• Advanced proficiency in Microsoft Office software including Word, Excel, Outlook and PowerPoint.
• Excellent clear, and concise oral and written communication skills.
• Strong organizational skills, including the ability to prioritize, multi-task and manage workload to meet specific timeframes and deadline.

Desirable Qualifications:

• Board Certification (any discipline) and completion of pharmacy residency.
• Analytical skills in health informatics with proficiency in statistical software applications or data visualization.
• Experience in promoting disease management or drug cost management programs.
• Experience in pharmacy residency preceptorship, mentoring, and/or experience managing teams and direct reports.
• Experience working for a Pharmacy Benefits Manager.
• Experience in fast-paced and dynamic work environment.

Pursuant to the State of Tennessee's Workplace Discrimination and Harassment policy, the State is firmly committed to the principle of fair and equal employment opportunities for its citizens and strives to protect the rights and opportunities of all people to seek, obtain, and hold employment without being subjected to illegal discrimination and harassment in the workplace. It is the State's policy to provide an environment free of discrimination and harassment of an individual because of that person's race, color, national origin, age (40 and over), sex, pregnancy, religion, creed, disability, veteran's status or any other category protected by state and/or federal civil rights laws.