At Blue Shield of California we are parents, leader, students, visionaries, heroes, and providers. Everyday we come together striving to fulfill our mission, to ensure all Californians have access to high-quality health care at a sustainably affordable price. For more than 80 years, Blue Shield of California has been dedicated to transforming health care by making it more accessible, cost-effective, and customer-centric. We are a not-for-profit, independent member of the Blue Cross Blue Shield Association with 6,800 employees, more than $20 billion in annual revenue and 4.3 million members. The company has contributed more than $500 million to Blue Shield of California Foundation since 2002 to have a positive impact on California communities. Blue Shield of California is headquartered in Oakland, California with 18 additional locations including Sacramento, Los Angeles, and San Diego. We're excited to share Blue Shield of California has received awards and recognition for - LGBT diversity, quality improvement, most influential women in corporate America, Bay Area's top companies in volunteering & giving, and one of the world's most ethical companies. Here at Blue Shield of California, we're striving to make a positive change across our industry and the communities we live in - Join us!Description: Job Summary
The Health Solutions team is made up of about 1,000 doctors, nurses, pharmacists, strategists, industry experts and innovators with a single vision - to transform the delivery of health care. Every day, we work together to improve the quality of patient care for our members while lowering health Care costs to ensure all Californians have access to the care they deserve.
How do we do it? Through partnership, innovation, and thought leadership.
We continue to expand our network of providers to ensure state-wide access to care. We evaluate analytic and digital health tools that simplify care delivery while improving member health status, health care quality and affordability as well as member and provider experience. We provide high-touch services to members from experienced clinical teams. You'll also find us collaborating with our federal and state legislative officials to help shape policy to advance our Blue Shield mission. Responsibilities
The Pharmacy Markets Strategy & Operations area is a key area within Pharmacy Service department with responsibilities to partner with key stakeholders cross-functionally for all lines of business to design and implement Pharmacy Products and market focused initiatives to provide affordable and quality pharmacy benefit coverage and enable membership growth and retention.
Reporting directly to the Senior Manager, Pharmacy Markets Strategy and Operations, the Principal Program Manager's key responsibilities to support Blue Shield's Commercial group lines of business include serving as the pharmacy liaison to drive, monitor and report out pharmacy product and program operational performance for internal and external stakeholders; drive accountability and progress to the pharmacy program operational performance in coordination with pharmacy and other key stakeholders, and leading the program development and implementation of pharmacy benefits/products. This position works closely with other pharmacy teams and cross functionally with other Blue Shield teams. The position may also support other lines of business as appropriate.
The individual may be based in our Oakland, Rancho Cordova, Woodland Hills office or may telecommute. Due to COVID-19 impact and current guidelines, the Principal Pharmacist will onboard and work remotely until Blue Shield resumes work in its office, no earlier than mid-2021.
Qualifications:Knowledge and Experience
- Serve as the primary pharmacy lead on monitoring, reporting, and driving efficiencies for pharmacy program operational performance and excellence for Blue Shield's Commercial group lines of business.
- Drive accountability and develop workplans with internal and external stakeholders to ensure progress with the pharmacy program operational performance.
- Drive end-to-end implementation of pharmacy product initiatives/program strategies, including business requirement sessions, product collateral updates and regulatory filings, for annual Commercial group portfolio refresh.
- Provide support for multiple cross-functional projects simultaneously, establishing work plans and timelines, and leading meetings efficiently to drive consensus among stakeholders.
- Support cross-functional teams on pharmacy technical matters, pharmacy program status or operational day-to-day management inquiries around pharmacy market initiatives, including benefit and product offerings.
- Provide support in the evaluation, assessment and implementation of pharmacy mandates and regulations.
- Strong program/project management skills, as demonstrated through experience leading and managing complex, cross-organizational, multi-stakeholder projects with a successful track record of delivery required.
- Demonstrated ability to work independently and collaboratively with multi-disciplinary teams with minimal oversight and direction from the manager required.
- Experience in pharmacy benefit implementation for Medicare, Medicaid or Commercial/Exchange membership is preferred.
- General familiarity with regulatory processes and guidelines governing health insurance products preferred.
- Other duties as assigned.
- Bachelor's degree and ten years working experience of health plan or PBM operational experience required, or an equivalent combination of education and experience.
- Working knowledge of Blue Shield of California's mission, vision, and strategy.
- Possesses excellent presentation, verbal, and written skills with ability to understand and convey complex ideas to audience with diverse backgrounds required.
- Must be proficient in MS Office, particularly MS Word, PowerPoint, and Excel.
- Detail-oriented with the ability to work in a fast-paced environment required.
- Able to work independently with minimum direction or supervision required.
- Possesses strong collaboration and partnership skills in a matrixed work environment required.
- Possesses strong business acumen with proven experience in thinking strategically preferred.
- Exhibits "can do" attitude and solution-oriented approach to resolve challenges preferred.
- Demonstrate ability to manage challenging situations in a positive and constructive manner.
- Produces accurate work under tight deadlines.