Executive Lead, Pharmacy Prior Authorization & Call Center

Blue Shield of CA; Minneapolis (MN); Hybrid; USD 180,000 - 320,000; Full time

Job summary

Blue Shield of California’s Pharmacy team seeks a Senior Director of Pharmacy Prior Authorization and Call Center. This role leads a team of 200+ professionals to design, implement, and optimize prior authorization and call center workflows, ensuring clinically appropriate and cost-effective patient care across pharmacy and medical benefits.

The candidate will partner with the Medical Director and vendors to enhance access, affordability, and compliance, while fostering leadership development

Qualifications

• Requires a current 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.
• 12 years of prior experience in managed care, PBM, or similar settings; pharmacy prior authorization and call center operations; strategic operational planning.
• 6 years of people management experience with direct supervision and coaching responsibilities.
• Vendor management and oversight experience preferred.
• Strong knowledge of pharmacotherapy guidelines and PBM networks preferred.
• Excellent communication and analytical skills; data-informed decision making.

Responsibilities

• Design, execute, and optimize prior authorization and call center processes to ensure clinically appropriate, cost-effective patient care.
• Collaborate cross-functionally with Medical Director and external vendors to improve patient access and affordability.
• Lead a large team, driving performance, accountability, and continuous improvement in operations.

Skills

RPh license

Leadership experience

Vendor management

Data-driven decisions

Strategic thinking

Interpersonal communication

Education

PharmD degree

Job description

Blue Shield of California’s Pharmacy team seeks a Senior Director of Pharmacy Prior Authorization and Call Center. This role leads a team of 200+ professionals to design, implement, and optimize prior authorization and call center workflows, ensuring clinically appropriate and cost-effective patient care across pharmacy and medical benefits.

The candidate will partner with the Medical Director and vendors to enhance access, affordability, and compliance, while fostering leadership development