Director, Clinical Systems Operations (Pharmacy)

Position Purpose: Oversee the development, implementation, and operation of medical management information systems and/or new technology solutions to meet Corporate, Health Plan, and Specialty business unit needs. Key Details: This is a remote Director, Clinical Systems Operations (Pharmacy) opportunity supporting Eastern or Central business hours. The team will consist of 11 individuals, including 4 direct reports. This role will lead Clinical Systems for the Pharmacy team, coordinating 50+ clinical program and initiative workflows across various business rules and overseeing 10,000+ programmed communications to members, providers, and pharmacies, with an annual volume of more than 8 million. Responsibilities include managing the systems that support direct clinical interactions with members and other clinical program activities; providing business rules for clinical data informatics to identify populations and medication-related problems by linking eligibility, medical, and pharmacy claims data across large data sets; and managing program triage to pharmacists and technicians based on program type, language, and state board of pharmacy licensure rules. The role will oversee system documentation and enhancements, business cases and business requirements, regulatory programming and reporting requirements, software defects, new feature implementation, vendor activities, system integrations, and User Acceptance Testing (UAT), while partnering closely with IT to support system a