Senior Director, Pharmacy - Prior Authorization & Call Center

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

Job summary

Blue Shield of California is seeking a Senior Director of Pharmacy Prior Authorization and Call Center to lead cross-functional teams and optimize POA and call center operations. You will design and implement strategic plans, ensure clinically appropriate and cost-effective patient care, and collaborate with vendors to improve access to medications across all lines of business.

The role emphasizes leadership development, high-performing teams, and continuous learning, with a hybrid in-office

Qualifications

• Requires a current active and unrestricted California Registered Pharmacist (RPh) license.
• Requires a Doctor of Pharmacy (PharmD) degree from a U.S. accredited school.
• Requires 12 years of experience in managed care/pharmacy benefit management or related settings with POA and call center operations.
• Requires 6 years of people management experience with direct reports.
• Vendor management and oversight experience preferred.
• Strong knowledge of therapeutic use of drugs and national guidelines preferred.
• Knowledge of pharmacy benefits, formulary, and network programs preferred.
• Strong financial acumen and data-driven decision making.
• Excellent interpersonal and written/verbal communication skills.
• Strategic and analytic thinking with data-informed problem-solving.

Responsibilities

• Design, execute, and optimize prior authorization processes and call center operations.
• Lead a team of 200+ employees and collaborate with Medical Director.
• Partner with vendors to optimize patient access and affordability across pharmacy and medical benefits.

Skills

Leadership

Strategic thinking

Analytical skills

Data-driven decision making

Communication

Vendor management

Education

PharmD

California RPh license

Job description

Blue Shield of California is seeking a Senior Director of Pharmacy Prior Authorization and Call Center to lead cross-functional teams and optimize POA and call center operations. You will design and implement strategic plans, ensure clinically appropriate and cost-effective patient care, and collaborate with vendors to improve access to medications across all lines of business.

The role emphasizes leadership development, high-performing teams, and continuous learning, with a hybrid in-office