Senior Pharmacist, Formulary Strategy Manager

Blue Shield of CA; Oakland (CA); Hybrid; USD 150,000 - 190,000; Full time

Job summary

Blue Shield of CA is seeking a Senior Manager, Pharmacist of Formulary Management to lead a team of pharmacists and operations specialists across CMS/Medicare formulary submissions, SERFF filings, and UM processes.

You will partner with analytics, product, actuary, and operations to develop strategies that improve affordability, quality, compliance, and member experience, while meeting regulatory requirements in US markets.

Qualifications

• Doctor of Pharmacy (PharmD) degree from an accredited school of pharmacy in the US.
• Active and unrestricted California Registered Pharmacist (RPh) license.
• At least 8 years of managed care pharmacy experience.
• 4 years of people management experience with direct responsibility for supervising, coaching, and evaluating direct reports.
• Experience with Medicare, ACA, Exchange, CMS/Medicare formulary and UM submissions, SERFF submissions, and other applicable regulatory requirements.
• Demonstrated ability to lead formulary and UM processes, projects, timelines, and cross-functional implementation activities.
• Strong independent judgment, analytical thinking, problem-solving skills, and ability to use data to drive decisions and results.
• Thorough knowledge of managed care and pharmacy benefit management practices, including UM.
• Advanced proficiency with Microsoft Office applications, including Excel, Access, and PowerPoint.

Responsibilities

• Lead a team of pharmacists and operations specialists responsible for formulary operations, CMS/Medicare formulary and UM submissions, SERFF submissions, formulary and UM implementation and adjudication accuracy.
• Partner with analytics, product, actuary, operations, vendors, and other business partners to develop and execute strategies that improve affordability, quality, compliance, and member experience.
• Contribute to the development and execution of strategies to support competitive health plan products and regulatory requirements.
• Provide leadership that develops great leaders at all levels and fosters continuous learning.

Skills

PharmD

California RPh

Managed care

People management

CMS/Medicare submissions

SERFF

Regulatory compliance

Data-driven decisions

MS Office

Analytical thinking

Education

PharmD degree

California Pharmacist License

Job description

Blue Shield of CA is seeking a Senior Manager, Pharmacist of Formulary Management to lead a team of pharmacists and operations specialists across CMS/Medicare formulary submissions, SERFF filings, and UM processes.

You will partner with analytics, product, actuary, and operations to develop strategies that improve affordability, quality, compliance, and member experience, while meeting regulatory requirements in US markets.