Director, Pharmacy Strategy and Performance

Blue Shield of California

California

Hybrid

USD 182,000 - 273,000

Full time

9 days ago

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Job summary

Blue Shield of California is seeking a Director, Pharmacist - Strategy and Performance to lead enterprise pharmacy strategy across pharmacy and medical benefits, overseeing drug contracting, performance and financial outcomes. You will partner with Pharmacy Clinical Leadership, Medical Management, Finance, Actuary, PBM partners and providers to drive drug trend management and maximize member value.

This role emphasizes leadership, analytical rigor, and cross-functional collaboration, with a

Qualifications

Active and unrestricted California RPh license.
PharmD from an accredited US school.
10+ years in managed care / PBM or related setting.
6+ years in people management with direct reports.
Strong communication for executive stakeholders.

Responsibilities

Lead development and execution of pharmacy affordability and value-based strategies across pharma and medical drug spend.
Oversee drug contracting, rebate and outcomes-based arrangements, and contract performance.
Design reimbursement and site-of-care strategies for cost-effective care.
Monitor network performance and evaluate new drug distribution models.
Present analyses and strategic recommendations to senior leadership.

Skills

RPh license

Leadership experience

Pharmacy benefits knowledge

Strategy & planning

Executive presentation skills

Education

PharmD degree (US)

Job description

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.

Job Description

The Director, Pharmacist - Strategy and Performance will report to the Vice President, Pharmacy Performance at BSC. In this role, you will lead a team responsible for developing and executing enterprise pharmacy strategy across the pharmacy and medical benefits. You will oversee drug and network contracting, contract performance, and financial performance across provider-administered drugs, home infusion, and retail and specialty pharmacy networks. Additionally, you will partner closely with Pharmacy Clinical Leadership, Medical Management, Finance, Actuary, Provider Contracting, and external pharmacy benefit management (PBM) partners to identify and implement strategies that improve drug trend management and maximize value for members, clients, and the organization.

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

Lead development and execution of pharmacy affordability and value-based strategies across both pharmacy and medical drug spend understanding industry trends, market dynamics, regulatory changes, and competitive landscape
Evaluate industry trends, market dynamics, and competitive landscape to help inform strategic decisions
Own enterprise drug contracting strategy across the pharmacy and medical benefits, including manufacturer agreements, rebate contracting, value-based and outcomes-based arrangements, financial guarantees, and related contract performance
Lead contracting and affordability strategies for drugs covered under the medical benefit, including provider-administered drugs and specialty therapies, in partnership with Provider Contracting and Network Management
Design and implement reimbursement and site-of-care strategies that promote delivery in clinically appropriate, cost-effective settings
Establish strategic direction, contracting requirements, and performance oversight for pharmacy and medical benefit networks, including retail, specialty pharmacy, home infusion, mail order, ancillary pharmacy, and provider networks supporting provider-administered drugs
Monitor financial, operational, access, and quality performance through key performance indicators and contractual guarantees and evaluate emerging network designs and alternative drug distribution models
Develop business cases and financial models supporting pharmacy strategic initiatives monitoring pharmacy trend, rebate performance, medical drug spend, and network economics
Utilize data analytics to evaluate utilization patterns, identify savings opportunities, and measure program effectiveness
Present performance results and strategic recommendations to senior leadership and executive stakeholders
Build strong partnerships with internal stakeholders, PBM leadership, providers, pharmaceutical manufacturers, and industry organizations

Qualifications

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 10 years of prior relevant experience in a managed care health plan or pharmacy benefit management company or other relevant settings
Requires 6 years of prior people management experience with direct responsibility for supervising, coaching, and evaluating direct reports
Requires excellent communication skills with prior experience in presentations to internal and external executive level business stakeholders
Knowledge of pharmacy benefits, formulary, network programs for drugs covered in pharmacy and medical benefits
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.

About Us

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

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.

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.

Equal Employment Opportunity

External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.

Job Information

Job Schedule : Full time