Senior Director, Pharmacy PA & Call Center Ops

Blue Shield of CA; Huntsville (AL); Hybrid; USD 250,000 - 420,000; Full time

Job summary

Blue Shield of California is seeking a Senior Director of Pharmacy Prior Authorization and Call Center to lead a team of 200+ associates and drive clinically appropriate, cost-effective patient care across pharmacy and medical benefits. You will design and optimize PA and call center operations, partner with Medical Director and vendors, and shape strategic plans for affordability and access.

This hybrid role requires in-office presence two days weekly and collaboration across functions to

Qualifications

• Requires a current active and unrestricted California Registered Pharmacist (RPh) license.
• Requires a Doctor of Pharmacy (PharmD) degree from an accredited school of pharmacy in the U.S.
• Requires 12 years of prior experience in: a managed care health plan or pharmacy benefit management companies or other relevant settings; pharmacy prior authorization program and call center operations; developing and implementing strategic operational plans to optimize efficiency and cost outcomes.
• Requires 6 years of prior people management experience with direct responsibility for supervising, coaching, and evaluating direct reports.
• Prior experience in vendor management and oversight preferred.
• Thorough knowledge regarding therapeutic use of drugs and available national guidelines preferred.
• Knowledge of pharmacy benefits, formulary, network programs for drugs covered in pharmacy and medical benefits preferred.
• Strong financial and business acumen with the ability to leverage performance data to drive operational improvements.
• Excellent interpersonal, written & verbal communication skills.
• Strategic and analytic thinking; problem-solving skills informed by data and evidence.

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.
• Partner with vendors and cross-functional teams to optimize patient access and affordability across pharmacy and medical benefits.
• Develop and implement strategic operational plans to improve efficiency and cost outcomes.
• Provide leadership and direction to ensure regulatory compliance and high performance.

Skills

Leadership

Strategic thinking

Data-driven

Interpersonal communication

Analytical thinking

Education

PharmD degree

California RPh license

Job description

Blue Shield of California is seeking a Senior Director of Pharmacy Prior Authorization and Call Center to lead a team of 200+ associates and drive clinically appropriate, cost-effective patient care across pharmacy and medical benefits. You will design and optimize PA and call center operations, partner with Medical Director and vendors, and shape strategic plans for affordability and access.

This hybrid role requires in-office presence two days weekly and collaboration across functions to