Pharmacy Prior Auth & Call Center Strategy Leader

Blue Shield of CA; Miami (FL); Hybrid; USD 250,000 - 360,000; Full time

Job summary

Blue Shield of California is seeking a Senior Director of Pharmacy Prior Authorization and Call Center to lead a large, mission-driven team in delivering clinically appropriate and cost-effective pharmacy and medical benefits. The role reports to the Senior VP of Pharmacy Services and requires leadership of over 200 staff, with a strong emphasis on performance, collaboration, and patient access.

Ideal candidates will bring extensive PBM/managed care experience, specialized pharmacy know-how, and

Qualifications

• Current active and unrestricted California Registered Pharmacist (RPh) license is required.
• Doctor of Pharmacy (PharmD) degree from a U.S. accredited school is required.
• 12 years in a managed care health plan or PBM or equivalent; and experience in prior authorization and call center operations.
• 6 years of people management with direct reports responsibility.
• Vendor management and oversight experience preferred.
• Therapeutic drug knowledge and familiarity with national guidelines preferred.
• Knowledge of pharmacy benefits, formulary, and network programs for PH/medical benefits preferred.
• Strong financial and business acumen with data-driven decision making.
• Excellent interpersonal, written, and verbal communication; strategic and analytic problem solving.

Responsibilities

• Design, execute, and optimize prior authorization and call center processes to ensure appropriate and cost-effective patient care.
• Lead and develop a team of 200+ employees, ensuring performance and accountability.
• Collaborate cross-functionally and with vendors to improve patient access to medications.
• Partner with Medical Director and senior leadership to align operations with business goals.

Skills

Leadership experience

Analytical thinking

Strategic thinking

Communication skills

Vendor management

Financial acumen

Team management

Pharmacy knowledge

Education

PharmD degree

CA RPh license

Job description

Blue Shield of California is seeking a Senior Director of Pharmacy Prior Authorization and Call Center to lead a large, mission-driven team in delivering clinically appropriate and cost-effective pharmacy and medical benefits. The role reports to the Senior VP of Pharmacy Services and requires leadership of over 200 staff, with a strong emphasis on performance, collaboration, and patient access.

Ideal candidates will bring extensive PBM/managed care experience, specialized pharmacy know-how, and