Job DescriptionYour Role The Pharmacy Cost of Health Care (COHC) Strategy and Drug Trend Management team develops and implements drug management and cost-of-care initiatives across medical and pharmacy benefits. The Sr. Manager, Pharmacy of COHC Strategy and Drug Trend Management will report to the Director, Formulary Strategy, COHC Management, and Pharmacy and Therapeutics. In this role, you will lead end-to-end drug strategy development and implementation, including network, clinical (formulary and utilization management), benefit design, and provider- and member-directed strategies to support clinically appropriate, affordable drug coverage across all lines of business.
ResponsibilitiesYour Work In this role, you will:
- Analyze drug cost, utilization, and treatment-mix trends across medical and pharmacy benefits to identify emerging cost drivers and recommend clinically appropriate affordability strategies.
- Partner with cross-functional teams to prioritize, implement, maintain, and monitor a drug cost management roadmap based on clinical value, financial impact, and operational feasibility.
- Develop evidence-based drug management strategies using treatment guidelines, claims analysis, competitive intelligence, pipeline assessments, financial and market data, and provider partnerships.
- Develop and evaluate drug contracting strategies, including traditional rebate arrangements and innovative contracting models, in partnership with contracting, clinical, and financial teams to improve net drug costs and support clinically appropriate access across medical and pharmacy benefits.
- Analyze medical and pharmacy benefit drug claims data to quantify unit cost trends and evaluate specific cost management opportunities.
- Partner with Analytics, Finance, Actuarial, and initiative owners to validate savings estimates, measure realized results, and recommend adjustments.
- Lead pipeline assessments of new drugs and indications, including disease prevalence, eligible populations, anticipated uptake, and budget impact for specialty and traditional drugs across medical and pharmacy benefits.
- Lead cross-functional implementation of drug management initiatives, coordinating clinical recommendations and operational requirements with internal partners.
- Communicate drug trend findings, financial implications, and recommended actions to line-of-business owners, Finance, and other stakeholders.
QualificationsYour Knowledge and Experience - Doctor of Pharmacy (PharmD) degree.
- Active and unrestricted California Registered Pharmacist (RPh) license.
- At least four years of managed care pharmacy experience.
- Strong independent judgment, analytical thinking, and problem-solving skills, with the ability to use data to drive decisions and results.
- Experience in pharmacy benefit management operations and demonstrated ability to interpret pharmacy benefit utilization and financial data.
- Knowledge of medical-benefit drug management and experience interpreting medical-benefit drug claims data preferred.
- Advanced proficiency in Microsoft Excel and PowerPoint, with experience using analytical and data management tools.
- Strong business acumen and demonstrated strategic thinking.
- Strong data analysis and data management skills, including the ability to analyze summarized and detailed claims information.
- Strong presentation, verbal, and written communication skills, with the ability to explain complex clinical and financial findings to audiences with varied backgrounds
HybridThis 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.
About the TeamAbout Blue Shield of CaliforniaAs 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.
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.
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