Vice President Pharmacy Services
About the job
- A Bachelor of Science in Pharmacy or PharmD is required.
- Must possess a Maine and New Hampshire pharmacy license or be eligible to obtain them.
- Requires 10 years of experience, including managed care experience such as PBM, HMO, or group practice experience, and retail pharmacy experience such as chain, independent, or mail order experience.
- Experience leading complex cross-functional projects and implementations.
- Experience with pharmacy vendor management, contract oversight, and review of key contractual elements.
- Experience supporting Medicare bid development, formulary strategy, or pharmacy financial analysis.
- Experience evaluating pharmacy programs and policies from both clinical and financial perspectives.
- Experience reviewing financial reports, reconciliations, invoices, and pharmacy trend data.
- Knowledge of Medicare Part D regulations and the Medicare annual bid process.
- Knowledge of pharmacy benefit design, formulary strategy, PBM operations, and pharmacy claims administration.
- Knowledge of pharmacy financial drivers, trend analysis, forecasting inputs, and invoice reconciliation processes.
- Knowledge of federal and state laws and regulations and applicable accreditation standards.
- Ability to evaluate pharmacy policies and initiatives using both clinical and financial business judgment.
- Understanding of drug pipeline trends and factors affecting pharmacy cost and utilization.
- Ability to establish accountability, design work processes around customer needs and expectations, prioritize, and think critically.
- Oral and written communication skills, interpersonal skills, delegation skills, and the ability to lead, build, mentor, and coach teams.
- Provide strategic and operational leadership for the Pharmacy division to achieve organizational goals related to financial performance, sustainability, growth, and pharmaceutical management targets established through strategic planning and budgeting.
- Direct the full scope of pharmacy operations, including formulary management, prior authorizations, formulary exceptions, medication adherence, patient accounting, billing practices, vendor billing oversight, and daily systems operations to ensure efficient, effective, and high-quality service delivery.
- Ensure Pharmacy division readiness for payer, regulatory, contractual, and accreditation requirements, including preparation for the CMS MA bid process and compliance with applicable vendor, payer, federal, state, and accreditation standards.
- Establish and oversee pharmacy performance metrics, data analysis, and quality improvement initiatives to evaluate divisional performance, improve patient care outcomes, strengthen contracted performance, and identify opportunities for operational and strategic process improvement.
- Ensure pharmacy-related policies are clinically sound with evidence-based medicine criteria and have appropriate utilization management activities, such as step therapy, for appropriate fiscal management.
- Partner across Pharmacy, Finance, Nursing, Medicine, Population Health, Practice, and other divisions to align clinical, administrative, and business processes, support patient-centered care, and promote appropriate prescribing, documentation, coding, reconciliation, and reimbursement practices.
- Provide leadership for pharmacy technology, systems optimization, and workforce planning, including technology assessment, software testing and implementation, operational system enhancements, staffing model development, and recruitment planning in partnership with Human Resources.
- Serve as the primary representative and spokesperson for the Pharmacy division, building internal and external relationships and advancing satisfaction among patients, members, providers, and other stakeholders across pharmacy services.
- Provide timely guidance regarding pharmacy market trends, legislative and regulatory developments, and consultant deliverables to inform strategic decision-making across the organization.
- A PharmD or MBA is preferred.
About the company
Martin's Point Health Care is a not-for-profit health care organization that provides medical services to individuals and families. Its offerings include a range of primary and specialty care delivered through clinics and care teams, with a focus on coordinated, accessible patient care and preventive services. The company reinvests profits back into the organization to improve care, expand community benefits, and keep services affordable. Unlike for-profit competitors, it emphasizes community health impact and long-term patient relationships, supported by a mission-driven, member- or patient-centered approach. The goal is to improve the health of the communities it serves by delivering high-quality, affordable care and reinvesting earnings to enhance services and access.
Company Size
501-1,000
Company Stage
N/A
Total Funding
N/A
Headquarters
Portland, Oregon
Founded
1981
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Simplify's Take
What believers are saying
- New telehealth for urgent care and mental health expands low-friction utilization in 2026.
- Provider guidance on HEDIS, coding, and prior authorization signals active margin and quality defense.
- Martin's Point still accepts new patients across Southern Maine and New Hampshire, supporting growth.
What critics are saying
- InterMed drops Martin's Point Medicare Advantage in January 2027, threatening 4,500 members.
- DOJ settlement for 2016-2019 risk-adjustment fraud still damages trust and CMS scrutiny.
- TRICARE contract dependence creates existential exposure if Defense rebids or tightens terms.
What makes Martin's Point Health Care unique
- Nonprofit Maine anchor spanning care delivery, Medicare Advantage, and TRICARE Prime since 1858.
- Six Health Care Centers plus payer contracts create integrated referral, data, and retention loops.
- 2026 Medicare stars stayed competitive: HMO 4-star, Select LPPO 3.5-star.
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Company News
St. Albans glass awarded martin's point health care contract. The details: Location: Portland, Maine Contractor: PC Construction Architect: SMRT Architects & Engineers and Sebago Technics
PORTLAND, Maine, July 31, 2023 /PRNewswire/ -- Today, Martin's Point Health Care announced that it has agreed to a settlement with the U.S. Department of Justice (DOJ) to resolve an investigation related to Martin's Point's Risk Adjustment practices for the payment years 2016-2019. The claims resolved by the settlement are allegations only, and there has been no determination of liability. The settlement is not related to member care or the payment of member claims.Martin's Point worked collaboratively with the DOJ during the course of the investigation. Despite denying liability for the litigation claims at issue, Martin's Point ultimately determined that settlement of this matter was appropriate rather than engaging in the cost and uncertainty of protracted litigation.A spokesperson for the organization commented: "This settlement is not an admission of liability, it instead allows us to avoid the disruption, expense, and uncertainty of litigation. It is important to note that this investigation is unrelated to member care or payment of member claims