Blue Shield Of California

Director, Specialty Pharmacy and Cost of Health Care

Blue Shield Of California$150K — $180K *
Healthcare
8 - 10 years of experience
Job Overview by Ladders

Qualifications

  • Active and unrestricted California Registered Pharmacist (RPh) license required.
  • Doctor of Pharmacy (PharmD) degree from an accredited U.S. pharmacy school required.
  • Minimum 10 years of relevant experience in evaluating pharmacy program performance.
  • At least 6 years of management experience in health plans or pharmacy benefit management.
  • Strong communication skills for engaging with executive stakeholders necessary.
  • Experience in vendor partnerships, contract operations, and negotiations preferred.
  • Proven success in pharmacy strategy development and planning expertise required.

Responsibilities

  • Oversee and direct a team of pharmacists and program managers.
  • Manage the end-to-end Specialty Drug Management Program for sustainability.
  • Collaborate with network teams on innovative reimbursement contracts.
  • Work with clinical and benefit product teams to refine program strategies.
  • Negotiate and manage specialty vendor contracts and outcomes effectively.
  • Evaluate manufacturer partnership programs and contracting opportunities.
  • Develop and implement the roadmap for Cost of Health Care initiatives by business line.

Benefits

  • Hybrid work model allowing flexibility with in-office requirements.
  • Opportunity for personal and professional growth within the organization.
  • Commitment to creating a supportive workplace environment.
  • Encouragement of continuous learning and development among employees.
  • Support for reasonable accommodations for employees with medical conditions.
Full Job Description
Job Description

Your Role

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.

Responsibilities

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


Qualifications

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.

#LI-JS1

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.

About Blue Shield Of California

Blue Shield of California is a not-for-profit health plan provider that has been providing Californians with access to high-quality healthcare for over 80 years. The company offers a range of health insurance products and services to individuals, families, and employers. Blue Shield of California is committed to improving the health and wellbeing of its members and the communities it serves. The company is also committed to sustainability and has implemented a number of initiatives to reduce its environmental impact.
Learn more about Blue Shield Of California
Size
7,000 employees
Industry
Founded
1981

Similar Jobs

More Jobs at Blue Shield Of California

More Healthcare Jobs

Find similar Director, Specialty Pharmacy and Cost of Health Care jobs: