ASSOCIATE PHARMACY DIRECTOR - 71131

Executive Service

Minimum Monthly Salary $9,761/month TennCare compensation is equitable and will be based on education and experience for a qualified candidate in accordance with Department of Human Resources (DOHR) policy.

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 directorssupporting 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:

• Support and maintain accountability for TennCare pharmacy policy development and deployment
• Support the development, implementation, and periodic review of TennCare pharmacy coverage policies to ensure consistency with Medicaid regulations, CMS guidelines, and clinical best practices.
• Translate clinical evidence, program data, and statutory requirements into actionable pharmacy benefit strategies.
• Support policy changes related to prior authorization, formulary management, and medical/pharmacy claims integration.
• Oversee development of internal documentation, provider guidance, and committee-facing materials for Drug Utilization Review (DUR), Pharmacy Advisory Committee (PAC), and other forums.
• Assist in developing pharmacy-related portions of State Plan Amendments (SPAs), legislative analyses, and federal or audit responses.
• 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.
• Develop and refine provider notices, policy summaries, and FAQs to explain changes in coverage or program operations.
• 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.
• 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.
• Support pharmacy directors and Associate Medical Directors in assessing financial and clinical impacts of benefit changes, and in clinical, operational, and ancillary program management.
• Maintain internal tracking systems, dashboards, and audit-ready documentation.
• Integrate pharmacy considerations into multi-disciplinary efforts like MAT network design, BESMART, and RxSMART programs.
• Participate in regular data reviews with PBMs and MCOs to address adjudication issues and coverage misalignment. Foster transparency and partnership through clear, collaborative engagement with pharmacy stakeholders
• Promote consistent, informative communication with providers, contractors, and advocacy partners to ensure understanding of TennCare pharmacy policies, reimbursement protocols, and benefit expectations.

Minimum Qualifications:

Education and Experience: Graduation from an accredited college or university with a bachelor's degree in Pharmaceutical science and experience equivalent to two years of full-time responsible work as a pharmacist.

Substitution of Education for Experience: Completion of one year of residency. Necessary Special Qualifications: Licensed as a Pharmacist in the State of Tennessee.

Examination Method: Education and Experience,100%, for Preferred Service positions.

For Executive Service positions, Minimum Qualifications, Necessary Special Qualifications, and Examination Method are determined by the appointing authority.

Desirable Qualifications:

1. Doctor of Pharmacy (PharmD) from an ACPE-accredited institution.
2. Active and unrestricted license to practice pharmacy in the State of Tennessee (or eligibility for licensure upon hire).
3. At least 3 years of professional experience in pharmacy policy, claims adjudication, or program operations within a PBM, MCO, or Medicaid program environment.
4. Experience supporting or participating in pharmacy benefit policy development, prior authorization review, or formulary management.
5. Familiarity with state Medicaid programs, CMS oversight structures, and TennCare-specific operational requirements.
6. Demonstrated working knowledge of pharmacy and medical billing practices, claims processing systems, and Medicaid-related reimbursement methodologies.
7. Strong analytical and problem-solving skills, with experience interpreting and applying pharmacy utilization data.
8. Proficient in Microsoft Office Suite (particularly Excel, Word, PowerPoint); experience with data tools such as SAS, SQL, or Tableau is a plus.
9. Effective written and verbal communication skills, with the ability to translate complex clinical or regulatory concepts for diverse audiences.
10. Master's degree in health care administration, public health, business administration, communications, or related field
11. Certifications in Lean Six Sigma or quality improvement
12. Prior experience working in or with a managed care pharmacy program or PBM in a policy, audit, clinical operations, or analytics capacity.
13. Board certification in pharmacotherapy (BCPS), ambulatory care (BCACP), or other relevant specialty area is a plus.
14. Exposure to quality improvement projects, performance measurement frameworks, or interdisciplinary program design.
15. Collaborative working style, with demonstrated ability to manage cross-functional work and support senior leaders.

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.