Manager, Pharmacy Utilization Management

Premera Blue Cross; Mountlake Terrace (WA); Hybrid; USD 150,000 - 271,000; Full time

Benefits offered by this job

Medical, vision, dental coverage

401K employer match

Tuition assistance

Job summary

Premera Blue Cross is hiring a Manager of Pharmacy Utilization Management in hybrid Washington state. This leadership role combines clinical expertise with operations to shape Pharmacy UM, aligning reviews with strategic direction for both pharmacy and medical benefits.

You will oversee the team, drive program development, and collaborate with Sales and Marketing. A PharmD or equivalent advanced degree, and a current pharmacist license are required.

Qualifications

• Strong leadership and people management abilities.
• Track record in clinical program development or PBM/managed care settings.
• Excellent verbal and written communication; ability to present to diverse audiences.

Responsibilities

• Oversee day-to-day team operations and achieve department goals.
• Ensure clinical programs and operations align with Premera's Pharmacy Program strategy.
• Develop monitoring and improvement plans for pharmacy clinical programs and processes.
• Lead PBM/vendor setup, testing, and issue resolution.
• Support sales and marketing with clinical and medical management insights.

Skills

Leadership

Communication

Project management

Analytical skills

Education

Pharmacist advanced degree (PharmD, MBA, MHA, MPH)

Tools

LEAN / Six Sigma certifications

Job description

• Active state Pharmacist License. (Required)

Workforce Classification

Hybrid

Join Our Team: Do Meaningful Work and Improve People’s Lives

Our purpose, to improve customers’ lives by making healthcare work better, is far from ordinary. And so are our employees. Working at Premera means you have the opportunity to drive real change by transforming healthcare.

Premera is committed to being a workplace where people feel empowered to grow, innovate, and lead with purpose. By investing in our employees and fostering a culture of collaboration and continuous development, we’re able to better serve our customers. It’s this commitment that has earned us recognition as one of the best companies to work for. Learn more about our recent awards and recognitions as a greatest workplace.

Learn how Premera supports our members, customers and the communities that we serve through our Healthsource blog: https://healthsource.premera.com/.

About The Role Of The Manager, Pharmacy Utilization Management

The Manager, Pharmacy Utilization Management is a newly created leadership role that brings together clinical expertise and operational leadership to help shape the future of Pharmacy Utilization Management (UM) at Premera. This role offers the opportunity to connect the department’s strategic direction with the evolving needs of its review operations, supporting a more unified approach across pharmacy benefit and medical benefit drugs. You’ll help position Pharmacy UM for its next phase as workforce models, workflows, and technology evolve.

What you’ll do:

• Oversee day-to-day activities of the team, including staff management, achieving department goals and team effectiveness.
• Ensure clinical programs, operations and consulting focus effectively delivers on the strategic direction of Premera's Pharmacy Program while meeting the needs of customers.
• Develop and maintain monitoring and ongoing improvement strategy for pharmacy clinical programs, operations, or consulting. Areas of focus may include:
• Drug Utilization Management/Prior Authorization across Medical and Pharmacy benefit
• Quality accreditation reporting and documentation and required procedures for pharmacy.
• Pharmacy benefit manager (PBM) and other vendor set-up, testing and issue resolution
• Specialty pharmacy set-up, testing and escalated specialty pharmacy customer issues.
• Formulary Program and Formulary Promotions, including oversight of Pharmacy and Therapeutics (P&T) Committee
• Responsible for hiring, performance management, training, and professional development of team.
• Provide clinical training, and business support of pharmacy and medical management strategies and solutions to Sales and Marketing Department including sales of the pharmacy benefit to clients (current and prospective clients)
• Contribute to and manage completion of pharmacy and clinical/medical management content in Request for Proposals (RFPs).
• Complete special projects and other duties as assigned.
• As part of this role, you may be assigned internal controls derived from Premera’s internal controls framework. You will be accountable for understanding the controls assigned to you, their impacts on Premera, and to ensure that they are operating effectively.

What you’ll bring:

• Pharmacist with an advanced degree (e.g. PharmD, MBA, MHA, MPH). (Required)
• Active state Pharmacist License. (Required)
• Six (6) years’ of pharmacy experience with at least two (2) years’ experience focused in any combination of the following: clinical program development, pharmacy consulting experience working in a Pharmacy Benefit Management (PBM) or in a health plan. (Required)
• Completion of the American Society of Health-System Pharmacists ASHP-accredited residency program. (Preferred)
• Experience with project management. (Preferred)
• Experience in a managed care pharmacy. (Preferred)
• Demonstrated ability to lead and manage multiple, complex, concurrent projects or teams.
• Ability to communicate effectively verbally and in writing; strong presentation skills.
• Proven ability to build and maintain relationships with both internal and external individuals.
• Strong analytical skills; Demonstrated experience analyzing trends and making recommendations based on the analysis.
• Working knowledge of local and regional health care issues.
• Ability to work independently, as well as a member of a team.
• Intermediate MS Word, Excel, PowerPoint and Outlook skills.
• LEAN program/process experience/certification, Six Sigma experience/certification or other process improvement program experience/certification.

Premera total rewards

Our comprehensive total rewards package provides support, resources, and opportunities to help employees thrive and grow. Our total rewards are more than a collection of perks, they're a reflection of our commitment to your health and well-being. We offer a broad array of rewards including physical, financial, emotional, and community benefits, including:

• Medical, vision, and dental coverage with low employee premiums.
• Voluntary benefit offerings, including pet insurance for paw parents.
• Life and disability insurance.
• Retirement programs, including a 401K employer match and, believe it or not, a pension plan that is vested after 3 years of service.
• Wellness incentives with a wide range of mental well-being resources for you and your dependents, including counseling services, stress management programs, and mindfulness programs, just to name a few.
• Generous paid time off to reenergize.
• Looking for continuing education? We have tuition assistance for both undergraduate and graduate degrees.
• Employee recognition program to celebrate anniversaries, team accomplishments, and more.

For our hybrid employees, our on-campus model provides flexibility to create your own routine with access to on-site resources, networking opportunities, and team engagement.

• Commuter perks make your trip to work less impactful on the environment and your wallet.
• Free convenient on-site parking.
• Subsidized on-campus cafes make lunchtime connections with colleagues fun and affordable.
• Participate in engaging on-site activities such as health and wellness events, coffee connects, disaster preparedness fairs and more.
• Our complementary fitness & well-being center offers both in-person and virtual workouts and nutritional counseling.
• Need a brain break? Challenge someone to a game of shuffleboard or ping pong while on campus.

Equal employment opportunity/affirmative action

Premera is an equal opportunity/affirmative action employer. Premera seeks to attract and retain the most qualified individuals without regard to race, color, religion, sex, national origin, age, disability, marital status, veteran status, gender or gender identity, sexual orientation, genetic information or any other protected characteristic under applicable law.

If you need an accommodation to apply online for positions at Premera, please contact Premera Human Resources via email at [e-mail] or via phone at 425-918-4785.

The pay for this role will vary based on a range of factors including, but not limited to, a candidate’s geographic location, market conditions, and specific skills and experience.

The salary range for this role is posted below; we generally target up to and around the midpoint of the range.

National Plus Salary Range

$150,300.00 - $270,500.00

• National Plus salary range is used in higher cost of labor markets including Western Washington and Alaska.

We’re happy to discuss compensation further during the interview because we believe that open communication leads to better outcomes for all. We’re committed to creating an environment where all employees are celebrated for their unique skills and contributions.