Job Description

Your Role

The Pharmacist Clinical Program Manager, Provider Partnership team supports the development, implementation, coordination, and assessment of pharmacy initiatives with the goal of providing high quality and affordable care to Blue Shield of California's members. The Business Analyst, Consultant will report to the Senior Pharmacist Manager of the Pharmacist Clinical Program Manager, Provider Partnership team. In this role you will be a subject matter expert for related programs to ensure that business requirements are established and maintained, key performance indicators are defined and monitored, and new ideas are evaluated to support data-driven decisions. You will work with an agile mindset, applying tenets of the Agile framework to drive high performing results for clinical pharmacy programs.

Responsibilities

Your Work

In this role, you will:

• Provide highly complex analytical support through the analysis and interpretation of data in support of cross-functional business operations
• Lead the development of annual operating plans, capital budgets and forecasts, and build business cases for new business initiatives (cost/benefit analysis)
• Develop, prepare, and analyze reports with highly complex analysis and data for management review, and presents to various levels of management
• Define business requirements and provide analysis to increase operational efficiency
• Provide analytical support for multiple, highly complex cross-functional projects simultaneously, establish work plans and timelines, coordinate with internal and external resources
• Improve processes, systems, and products to enhance the performance of the Clinical Pharmacy Program Manager Provider Partnership Team
• Provide business analytic support to inform strategies that help ACO groups achieve risk share and quality targets and Medicare groups meet quality measure goals, including analysis of key performance indicators and risk share models.
• Provide business analytic support to any new technologies or strategies that enable and enhance clinical quality improvement and drug cost affordability.
• Collaborate with other business areas, including Data and Analytics, Digital Experience, I.T. to research, design, build, test, monitor, and enhance clinical pharmacy programs to achieve defined goals.
• Support professional growth and employee engagement for yourself and others by being a key resource to advise and mentor other team members

Qualifications

Your Knowledge and Experience

• Requires a college degree or equivalent experience
• Requires at least 7 years of prior relevant experience
• A minimum of 3 years' experience in managed care pharmacy is preferred
• Requires strong analytic and problem-solving skills with intermediate to advanced knowledge of pharmacy data elements and related technical standards/concepts (e.g. claims, e-prescriptions, e-prior authorization, real time pharmacy benefits, etc.)
• Requires advanced proficiency in Microsoft applications including Word, Excel, Power Point, Power Query, Power BI, OneNote, SharePoint
• Requires excellent written, verbal, and interpersonal communication skills
• Requires experience working independently in a fast-paced environment

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 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.

About the Team

About Blue Shield of California

As of January 2025, Blue Shield of California became a subsidiary of Ascendiun. Ascendiun is a nonprofit corporate entity that is the parent to a family of organizations including Blue Shield of California and its subsidiary, Blue Shield of California Promise Health Plan; Altais, a clinical services company; and Stellarus, a company designed to scale healthcare solutions. Together, these organizations are referred to as the Ascendiun Family of Companies.

At Blue Shield of California, our mission is to create a healthcare system worthy of our family and friends and sustainably affordable. We are transforming health care in a way that genuinely serves our nonprofit mission by lowering costs, improving quality, and enhancing the member and physician experience.

To achieve our mission, we foster an environment where all employees can thrive and contribute fully to address the needs of the various communities we serve. We are committed to creating and maintaining a supportive workplace that upholds our values and advances our goals.

Blue Shield is a U.S. News Best Company to work for, a Deloitte U.S. Best Managed Company and a Top 100 Inspiring Workplace. We were recognized by Fair360 as a Top Regional Company, and one of the 50 most community-minded companies in the United States by Points of Light. Here at Blue Shield, we strive to make a positive change across our industry and communities - join us!

Our Values:

• Honest. We hold ourselves to the highest ethical and integrity standards. We build trust by doing what we say we're going to do and by acknowledging and correcting where we fall short.
• Human. We strive to listen and communicate effectively, showing empathy by understanding others' perspectives.
• Courageous. We stand up for what we believe in and are committed to the hard work necessary to achieve our ambitious goals.

Our Workplace Model

We believe in fostering a workplace environment that balances purposeful in-person collaboration with flexibility - providing clear expectations while respecting the diverse needs of our workforce. Our workplace model is designed around intentional in-person interaction, collaboration, connection, creativity and flexibility:

• For most teams, this means coming into the office two days per week.
• Employees living more than 50 miles from an office location, out of state employees, and employees in certain member-facing roles should work with their manager to determine in-office time based on business need.
• For employees with medical conditions that may impact their ability to work in-office, we are committed to engaging in an interactive process and providing reasonable accommodations to ensure their work environment is conducive to their success and well-being.

The Company reserves the right to require more presence in the office based on business needs, and requirements are subject to change with periodic reviews.

Physical Requirements:

Office Environment - roles involving part to full time schedule in Office Environment. Based in our physical offices and work from home office/deskwork - Activity level: Sedentary, frequency most of work day.

Please click here for further physical requirement detail.