Executive Director, Pharmacy Prior Authorization & Call Center

Blue Shield of CA; Las Vegas (NV); Hybrid; USD 180,000 - 280,000; Full time

Job summary

The Blue Shield of California (BSC) Pharmacy team is pursuing a Senior Director, Pharmacy Prior Authorization and Call Center to lead and optimize PA and call center operations while ensuring clinically appropriate, cost-effective patient care. This role reports to the Senior Vice President of Pharmacy Services and supervises a team of over 200 employees.

In collaboration with the Medical Director, you will design, execute, and refine processes to improve efficiency, access, and affordability

Qualifications

• Requires a Doctor of Pharmacy (PharmD) degree from an accredited school of pharmacy in the U.S.
• Requires a current active and unrestricted California Registered Pharmacist (RPh) license
• Requires 12 years of prior experience in a managed care health plan or pharmacy benefit management settings; prior authorization and call center operations
• Requires 6 years of prior people management experience with direct supervision of staff
• Vendor management and oversight experience preferred
• Thorough knowledge of therapeutic use of drugs and national guidelines preferred
• Knowledge of pharmacy benefits, formulary, and network programs for drugs covered under pharmacy and medical benefits preferred
• Strong financial and business acumen with the ability to leverage performance data to drive operational improvements
• Excellent interpersonal, written, and verbal communication skills
• Strategic and analytic thinking; data-driven problem-solving skills

Responsibilities

• Design, execute, and optimize prior authorization and call center processes
• Ensure clinically appropriate, cost-effective, and compliant patient care
• Lead a large team (200+ employees) and collaborate with the Medical Director
• Partner with vendors to optimize patient access and affordability across pharmacy and medical benefits
• Foster leadership development and continuous learning across the organization

Skills

Leadership skills

Interpersonal communication

Strategic thinking

Analytical/problem solving

Financial/business acumen

Vendor management

Pharmacy benefits knowledge

Therapeutic drug knowledge

Data-driven decision making

Education

PharmD

California RPh license

Job description

The Blue Shield of California (BSC) Pharmacy team is pursuing a Senior Director, Pharmacy Prior Authorization and Call Center to lead and optimize PA and call center operations while ensuring clinically appropriate, cost-effective patient care. This role reports to the Senior Vice President of Pharmacy Services and supervises a team of over 200 employees.

In collaboration with the Medical Director, you will design, execute, and refine processes to improve efficiency, access, and affordability