Senior Pharmacist, Formulary Strategy & Leadership

Blue Shield of CA; Long Beach (CA); Hybrid; USD 150,000 - 210,000; Full time

Benefits offered by this job

Hybrid work model

Job summary

Blue Shield of California is seeking a Senior Manager, Pharmacist of Formulary Management to lead a team of pharmacists and operations specialists in formulary operations and regulatory submissions. This role reports to the Director, Formulary Strategy and Pharmacy & Therapeutics.

You will partner with analytics, product, actuary, operations, vendors, and other partners to improve affordability, quality, compliance, and member experience while guiding cross-functional implementation

Qualifications

• PharmD degree from a US-accredited school of pharmacy.
• Active and unrestricted California RPh license.
• 8+ years of managed care pharmacy experience.
• 4 years of people management experience supervising, coaching, and evaluating direct reports.
• Experience with Medicare, ACA, Exchange, CMS/Medicare formulary and UM submissions, SERFF submissions.
• Demonstrated ability to lead formulary and UM processes, projects, timelines, and cross-functional implementation activities.
• Strong independent judgment, analytical thinking, problem-solving, and data-driven decision making.
• Thorough knowledge of managed care and PBM practices, including UM.
• Advanced proficiency with Microsoft Office applications (Excel, Access, PowerPoint).

Responsibilities

• Lead a team of pharmacists and operations specialists responsible for formulary operations.
• Oversee CMS/Medicare formulary and UM submissions and SERFF filings.
• Ensure accurate formulary implementation and adjudication.
• Partner with analytics, product, actuary, operations, vendors, and other business partners to develop strategies.
• Drive affordability, quality, compliance, and member experience.

Skills

Leadership

PBM expertise

Data-driven decision making

Regulatory compliance

Analytical thinking

Cross-functional collaboration

Education

Doctor of Pharmacy (PharmD)

California RPh license

Tools

Excel

Access

PowerPoint

SERFF

Job description

Blue Shield of California is seeking a Senior Manager, Pharmacist of Formulary Management to lead a team of pharmacists and operations specialists in formulary operations and regulatory submissions. This role reports to the Director, Formulary Strategy and Pharmacy & Therapeutics.

You will partner with analytics, product, actuary, operations, vendors, and other partners to improve affordability, quality, compliance, and member experience while guiding cross-functional implementation