Head of Pharmacy Access & Prior Authorization

Blue Shield of CA; Denver (CO); Hybrid; USD 230,000 - 340,000; Full time

Job summary

Blue Shield of California is seeking a Senior Director of Pharmacy Prior Authorization and Call Center. The role leads a 200+ person team, partnering with the Medical Director to design, execute, and optimize prior authorization and call center operations for cost-effective, compliant patient care.

The position emphasizes strategic leadership, cross-functional collaboration, and vendor oversight to improve access and affordability across pharmacy and medical benefits for all business lines.

Qualifications

• Requires a Doctor of Pharmacy (PharmD) degree from an accredited school of pharmacy in the U.S.
• Requires current active and unrestricted California RPh license.
• 12+ years of experience in managed care/PHM settings; prior authorization and call center operations.
• 6+ years of people management experience with direct reports.
• Experience with vendor management is preferred.
• Strong financial acumen and ability to leverage data for improvements.
• Excellent interpersonal, written & verbal communication skills.
• Strategic and analytic thinking with data-informed problem solving.

Responsibilities

• Design, execute, and optimize prior authorization and call center processes to ensure clinically appropriate, cost-effective patient care.
• Lead and develop a team of 200+ employees across PA and call center operations.
• Collaborate cross-functionally with Medical Director and vendors to improve access and affordability across lines of business.

Skills

Leadership

Strategic thinking

Analytical thinking

Communication skills

Vendor management

Education

PharmD degree

CA Pharmacist license (RPh)

Job description

Blue Shield of California is seeking a Senior Director of Pharmacy Prior Authorization and Call Center. The role leads a 200+ person team, partnering with the Medical Director to design, execute, and optimize prior authorization and call center operations for cost-effective, compliant patient care.

The position emphasizes strategic leadership, cross-functional collaboration, and vendor oversight to improve access and affordability across pharmacy and medical benefits for all business lines.