Senior Director, Pharmacy Prior Authorization & Call Center

Blue Shield of CA; Washington (District of Columbia); Hybrid; USD 190,000 - 250,000; Full time

Job summary

The Blue Shield of California is seeking a Senior Director of Pharmacy Prior Authorization and Call Center. This role will design, execute, and optimize complex prior authorization and call center processes to ensure clinically appropriate and cost-effective patient care.

You will lead a large team and collaborate with the Medical Director and vendors to improve access and affordability across pharmacy and medical benefits.

Qualifications

• Current active and unrestricted California RPh license.
• PharmD from an accredited US school.
• 12 years in managed care, PBM or related settings.
• 6 years of direct people management experience.
• Strong financial and business acumen with data-driven improvements.
• Excellent interpersonal, written & verbal communication skills.
• Strategic and analytic thinking with data-informed problem solving.

Responsibilities

• Design, execute, and optimize prior authorization and call center processes to ensure clinically appropriate, cost effective patient care.
• Lead and develop a team of 200+ employees and collaborate with Medical Director.
• Partner with vendors to optimize patient access while supporting affordability of medications covered under pharmacy and medical benefits.

Skills

Active RPh license

PharmD degree

Managed care experience

People management

Vendor management

Drug therapy knowledge

Pharmacy benefits

Analytical thinking

Communication skills

Financial acumen

Education

PharmD degree

Job description

The Blue Shield of California is seeking a Senior Director of Pharmacy Prior Authorization and Call Center. This role will design, execute, and optimize complex prior authorization and call center processes to ensure clinically appropriate and cost-effective patient care.

You will lead a large team and collaborate with the Medical Director and vendors to improve access and affordability across pharmacy and medical benefits.