Senior Director, Pharmacy Prior Auth & Call Center (Hybrid)

Blue Shield of CA; Chicago (IL); Hybrid; USD 190,000 - 280,000; Full time

Job summary

Blue Shield of California seeks a Senior Director to lead the Pharmacy Prior Authorization and Call Center, directing a team of 200+ professionals. You will design and optimize processes to ensure clinically appropriate, cost-effective patient care and collaborate with Medical Director, vendors, and cross-functional partners.

The role emphasizes leadership development, data-driven improvements, and an enterprise-wide focus on affordability and access across pharmacy and medical benefits.

Qualifications

• Active California Pharmacist license
• PharmD degree from an accredited U.S. school of pharmacy
• 12 years in managed care health plan or PBM or related settings; prior authorization and call center ops
• 6 years of people management experience with direct reports
• Vendor management experience preferred
• Knowledge of pharmacotherapy and national guidelines preferred
• Knowledge of pharmacy benefits, formulary and network programs preferred
• Strong financial acumen with ability to leverage performance data for improvements
• Excellent interpersonal, written & verbal communication skills
• Strategic and analytic thinking with data-driven problem solving

Responsibilities

• Develop and optimize prior authorization and call center processes for clinically appropriate, cost-effective patient care
• Lead and manage a team of 200+; partner with Medical Director and cross-functional teams
• Collaborate with vendors to improve access and affordability across pharmacy and medical benefits
• Drive strategic operational plans to enhance efficiency and cost outcomes
• Support development of leadership across the organization and foster continuous learning

Skills

Strategic thinking

Analytical thinking

People management

Communication skills

Vendor management (preferred)

Education

PharmD degree (US)

California Pharmacist license

Job description

Blue Shield of California seeks a Senior Director to lead the Pharmacy Prior Authorization and Call Center, directing a team of 200+ professionals. You will design and optimize processes to ensure clinically appropriate, cost-effective patient care and collaborate with Medical Director, vendors, and cross-functional partners.

The role emphasizes leadership development, data-driven improvements, and an enterprise-wide focus on affordability and access across pharmacy and medical benefits.