Senior Director, Pharmacy Access & Prior Authorization

Blue Shield of CA; Virginia Beach (VA); Hybrid; USD 210,000 - 300,000; Full time

Job summary

Blue Shield of California is seeking a Senior Director, Pharmacy Prior Authorization and Call Center to lead design, execution, and optimization of prior authorization and call center processes. You will manage a large team and partner with the Medical Director to ensure clinically appropriate, cost-effective patient care across pharmacy and medical benefits.

We value strategic thinking, data-driven improvements, and strong vendor management as part of delivering affordable access to medications

Qualifications

• Requires active California RPh license.
• Requires PharmD from an accredited U.S. school of pharmacy.
• Requires 12 years of prior experience in managed care health plans or PBM.
• Requires 6 years of people management experience.
• Vendor management experience preferred.
• Knowledge of pharmacy benefits, formulary, and networks preferred.

Responsibilities

• Design, execute, and optimize prior authorization and call center processes to ensure clinically appropriate, cost-effective patient care.
• Lead a team of 200+ employees and collaborate with Medical Director and vendors to improve access and affordability.
• Develop and implement strategic operational plans to improve efficiency and cost outcomes.
• Foster cross-functional collaboration and ensure regulatory and compliance adherence.

Skills

RPh license

Pharmacist leadership

12+ years exp

People management

Vendor management

Pharmacy benefits knowledge

Data-driven

Communication skills

Strategic thinking

Education

PharmD

Job description

Blue Shield of California is seeking a Senior Director, Pharmacy Prior Authorization and Call Center to lead design, execution, and optimization of prior authorization and call center processes. You will manage a large team and partner with the Medical Director to ensure clinically appropriate, cost-effective patient care across pharmacy and medical benefits.

We value strategic thinking, data-driven improvements, and strong vendor management as part of delivering affordable access to medications