• Provides strategic leadership for clinical pharmacy initiatives across all lines of business • Oversee formulary, criteria, and prior authorization activities to ensure timely, compliant, and high-quality service delivery • Accountable for monitoring drug utilization trends, guiding performance standards, and ensuring regulatory compliance to support affordability and member outcomes • Lead the strategic direction, development, and execution of drug management programs • Direct leadership staff responsible for formulary creation, criteria development and maintenance, prior authorization evaluations, and utilization management monitoring • Oversee development and maintenance of clinical pharmacy policies and ensure compliance with accreditation standards (e.g., URAC, NCQA, CMS) • Lead and develop a high-performing team, fostering a culture of accountability, engagement, and continuous improvement, and professional growth • Coordinate with pharmacy benefit strategy leaders and corporate stakeholders to deliver competitive and cost-effective clinical services • Lead audit preparation and compliance initiatives to ensure coverage review operations meet internal and external standards • Ensure clinical functions meet expectations for value and affordability, driving continuous improvement and market responsiveness