Director, Specialty Pharmacy and Cost of Health Care

Your Role

The Blue Shield of California (BSC) Pharmacy team comprises of over 350 dedicated professionals who are passionate about making a meaningful impact by reimagining pharmacy care. Ensuring every member has safe, equitable access to sustainably affordable pharmacy benefits is at the heart of everything we do.

The Director, Pharmacist (Specialty Pharmacy and Cost of Health Care) will report to the Senior Vice President/Chief Pharmacy Officer. In this role, you will drive strategies and performance of pharmacy Cost of Health Care (COHC) programs to manage annual pharmacy benefit costs for over $5 billion. You will lead your team to work cross functionally and partner with vendors as appropriate to develop and implement end-to-end strategies and differentiating solutions in both pharmacy and medical benefits for Commercial and Medicare. You will also own and drive the Specialty drug management program including management of cell and gene therapies.

Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow - personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.

Your Knowledge and Experience

• Requires a currently active and unrestricted California Registered Pharmacist (RPh) license
• Requires a Doctor of Pharmacy (PharmD) degree from an accredited school of pharmacy in the U.S.
• Requires at least 10 years prior relevant experience, including evaluation of pharmacy program value and performance drivers
• Requires 6 years of management experience in health plans or pharmacy benefit management companies, with deep knowledge of pharmacy benefit, formulary and network products, program strategies and competitive landscape
• Requires excellent communication skills with prior experience in presentations to internal and external executive level business stakeholders
• Prior experience in vendor partnership, contract operations, negotiations, and performance management is preferred
• Strong business acumen with proven experience in pharmacy strategy development and planning
• Excellent presentation, verbal and written skills with ability to understand and convey complex ideas to audience with diverse backgrounds
• Detail-oriented with the ability to work in a fast-paced environment
• Exhibit a "can do" attitude and solution-oriented approach to resolve challenges

Hybrid

This role requires employees to be in-office based on our hybrid workplace model, balancing purposeful in-person collaboration with flexibility. For most teams, this means coming into the office two days each week.

Employees living more than 50 miles from an office location will work with their manager to determine in-office time based on business need.

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Your Work

In this role, you will:

• Oversee a team of pharmacists and program managers
• Own end-to-end Specialty Drug Management Program for specialty drugs covered under pharmacy and medical benefits to yield sustainable affordability
• Partner with network teams to contract and reimburse differently (e.g. acquisition cost based, ASP based, provider fee schedule, etc.) with medical and pharmacy network providers
• Partner with clinical and benefit product teams to optimize program strategies and effectiveness
• Negotiate and provide oversight and direct management of select specialty vendor contracts and outcomes
• Support evaluation of manufacturer partnership programs and contracting opportunities (e.g. rebates, outcomes-based contracts)
• Lead development and implementation of COHC initiative roadmap by lines of business (LOB) to meet trend and financial targets for Commercial and Medicare
• Partner with pharmacy analytics and LOB teams to proactively evaluate pharmacy trend drivers, evaluate program ROI, drive end-to-end COHC strategy and program design for pharmacy and medical benefit drug spend
• Lead implementation of select initiatives to support Pharmacy Care Reimagined and biosimilars adoption
• Evaluate emerging vendor solutions and partnership opportunities and support contract development and negotiation
• Build a high performing team and foster a great workplace to do meaningful work

Your Work

In this role, you will:

• Oversee a team of pharmacists and program managers
• Own end-to-end Specialty Drug Management Program for specialty drugs covered under pharmacy and medical benefits to yield sustainable affordability
• Partner with network teams to contract and reimburse differently (e.g. acquisition cost based, ASP based, provider fee schedule, etc.) with medical and pharmacy network providers
• Partner with clinical and benefit product teams to optimize program strategies and effectiveness
• Negotiate and provide oversight and direct management of select specialty vendor contracts and outcomes
• Support evaluation of manufacturer partnership programs and contracting opportunities (e.g. rebates, outcomes-based contracts)
• Lead development and implementation of COHC initiative roadmap by lines of business (LOB) to meet trend and financial targets for Commercial and Medicare
• Partner with pharmacy analytics and LOB teams to proactively evaluate pharmacy trend drivers, evaluate program ROI, drive end-to-end COHC strategy and program design for pharmacy and medical benefit drug spend
• Lead implementation of select initiatives to support Pharmacy Care Reimagined and biosimilars adoption
• Evaluate emerging vendor solutions and partnership opportunities and support contract development and negotiation
• Build a high performing team and foster a great workplace to do meaningful work