Senior Director, Pharmacy Prior Authorization & Call Center

Blue Shield of CA; Houston (TX); Hybrid; USD 180,000 - 260,000; Full time

Job summary

Blue Shield of California is seeking a Senior Director, Pharmacy Prior Authorization and Call Center to lead a team of over 200 professionals. The role focuses on designing, executing, and optimizing prior authorization and call center processes to ensure clinically appropriate, cost-effective, and compliant patient care.

Reporting to the Senior Vice President of Pharmacy Services, you will partner with the Medical Director and vendors to enhance patient access and affordability across all

Qualifications

• Current active California RPh license
• PharmD degree from an accredited U.S. school
• 12+ years in managed care/pharmacy benefit management or related settings
• 6+ years in people management with direct reports
• Vendor management experience preferred
• Knowledge of therapeutic use of drugs and national guidelines preferred
• Strong financial and business acumen with data-driven improvements
• Excellent interpersonal, written and verbal communication skills
• Strategic and analytic thinking with evidence-based problem solving

Responsibilities

• Lead a large team to design, execute, and optimize prior authorization and call center processes
• Collaborate cross-functionally with medical directors and vendors
• Drive clinically appropriate, cost-effective patient care and affordability across pharmacy and medical benefits
• Develop and implement strategic operational plans to improve efficiency and outcomes

Skills

Leadership

Strategic thinking

Analytical thinking

Data-driven decision making

Communication

Vendor management

Education

PharmD degree

CA Pharmacist license (RPh)

Job description

Blue Shield of California is seeking a Senior Director, Pharmacy Prior Authorization and Call Center to lead a team of over 200 professionals. The role focuses on designing, executing, and optimizing prior authorization and call center processes to ensure clinically appropriate, cost-effective, and compliant patient care.

Reporting to the Senior Vice President of Pharmacy Services, you will partner with the Medical Director and vendors to enhance patient access and affordability across all