Director Clinical Operations and Medical Policy

Location: Hybrid, three days per week in the office, at locations in Burlington, Renton, Spokane, Vancouver, Portland, Medford, Salt Lake City, Boise, Lewiston, or Fargo. Candidates must live within commuting distance or be willing to relocate.

Salary: $179,400–$242,700 expected hiring range in Oregon, Washington, Utah, and Idaho; $166,991.85–$225,930.15 expected hiring range in North Dakota. Full ranges and bonus targets vary by location.

Company

Healthcare organization focused on creating a person-centered and economically sustainable health care system.

What you will do

• Lead strategy and operations for pharmacy prior authorization, clinical review, appeals, formulary governance, and medical drug policy.
• Establish policy governance, decision rights, workflows, documentation standards, and clinical committee interfaces.
• Develop evidence-based coverage, utilization-management, specialty-drug, biosimilar, and therapeutic-substitution strategies.
• Own KPIs, service levels, quality measures, turnaround times, compliance indicators, and financial or utilization outcomes.
• Lead transformation across people, processes, technology, data, vendors, markets, and products.
• Partner with Pharmacy, Medical Management, Legal, Compliance, Finance, Technology, Analytics, providers, and senior leaders.

Requirements

• PharmD or Bachelor of Science in Pharmacy from an accredited school of pharmacy.
• Current pharmacist licensure in at least one U.S. jurisdiction and ability to obtain additional licenses if required.
• Eight or more years of experience in managed-care pharmacy, health-plan clinical operations, PBM, utilization management, or medical policy.
• Five or more years of formal leadership experience involving people, clinical or operational performance, and complex cross-functional initiatives.
• Deep knowledge of prior authorization, appeals, formulary and utilization management, evidence-based coverage policy, specialty drugs, and clinical governance.
• Experience with regulatory and accreditation requirements, audit readiness, delegated oversight, executive communication, and AI tools.

Culture & Benefits

• Purpose-driven culture focused on trust, innovation, inclusion, and sustainable person-focused health care.
• Medical, dental, vision, and mental health coverage, plus employer HSA contributions.
• Paid time off, company holidays, paid parental leave, wellness programs, and employee assistance support.
• 401(k) retirement plan with company match and potential discretionary contribution.
• Employee resource groups, community outreach opportunities, commute benefits, and work-from-home options for eligible roles.