Senior Director, Pharmacy Access & Prior Authorization

Blue Shield of CA; Portland (OR); Hybrid; USD 180,000 - 280,000; Full time

Job summary

Blue Shield of California seeks a Senior Director of Pharmacy Prior Authorization and Call Center to lead a large operations team and optimize processes for safe, cost-effective patient care.

In collaboration with the Medical Director, you will drive strategic initiatives across pharmacy benefits and vendor partnerships to improve access and affordability while maintaining compliance.

Qualifications

• This role requires an active CA Pharmacist license and a PharmD degree.
• At least 12 years in managed care or PBM settings with prior authorization expertise.
• Minimum 6 years of people management experience and vendor oversight preferred.
• Strong knowledge of pharmacy benefits, formulary and cost outcomes.

Responsibilities

• Lead a team of 200+ employees in PA and call center operations.
• Design, execute, and optimize prior authorization processes to ensure appropriate, affordable care.
• Collaborate with Medical Director and vendors to improve access and affordability.
• Drive performance using data analytics and cross-functional partnerships.

Skills

California RPh license

PharmD degree

12 years managed care/ PBM experience

6 years people management

vendor management

pharmacy benefits knowledge

data-driven decision making

strong communication skills

strategic thinking

Education

Doctor of Pharmacy (PharmD)

Job description

Blue Shield of California seeks a Senior Director of Pharmacy Prior Authorization and Call Center to lead a large operations team and optimize processes for safe, cost-effective patient care.

In collaboration with the Medical Director, you will drive strategic initiatives across pharmacy benefits and vendor partnerships to improve access and affordability while maintaining compliance.