Senior Specialty Pharmacy Network Strategy Lead

Blue Cross and Blue Shield of North Carolina; Milwaukee (WI); On-site; USD 89,000 - 143,000; Full time

Benefits offered by this job

Annual Incentive Bonus

401(k) with employer match

Paid Time Off (PTO)

Health benefits and wellness programs

Job summary

Blue Cross NC seeks a senior strategist to lead specialty pharmacy network design, contracting strategy, and cost-reduction initiatives. You will leverage industry expertise to identify market opportunities, design network-based pricing, and implement affordability solutions while maintaining member access and regulatory compliance.

The role requires 5+ years in related fields, with a Bachelor’s or advanced degree; seven+ years can substitute for a degree.

Qualifications

• Bachelor's degree or advanced degree (where required).
• 5+ years of experience in related field; in lieu of degree, 7+ years of experience.

Responsibilities

• Proactively identify, analyze, evaluate, and implement specialty pharmacy network strategies that support affordability and access.
• Develop and execute network optimization strategies, including design, pricing approaches, and reimbursement methodologies.
• Support strategic planning, financial analysis, and business case development to inform contracting decisions and affordability initiatives.
• Translate complex network dynamics into clear recommendations for internal stakeholders and senior leadership.
• Present strategies, metrics, and impact assessments to executives and other audiences across the enterprise.
• Collaborate with other departments and external partners to advance specialty pharmacy affordability solutions.
• Monitor industry trends, regulation, and market dynamics affecting network performance and costs.
• Engage with specialty pharmacies, PBMs, vendors, and providers to evaluate opportunities and resolve challenges.
• Synthesize progress and outcomes to support alignment, accountability, and decision-making.
• Advance network strategy and contracting capabilities to achieve sustainable unit cost reductions.

Skills

Healthcare Consulting

Healthcare Financial Management

Healthcare Industry

Healthcare Innovation

Healthcare Management

Healthcare Strategic Planning

Health Outcomes

Medical Reimbursement

Performance Metrics

Physician Reimbursement

Project Management

Provider Reimbursement

Reimbursement

Reporting and Analysis

Education

Bachelor's degree

Advanced degree

Job description

Blue Cross NC seeks a senior strategist to lead specialty pharmacy network design, contracting strategy, and cost-reduction initiatives. You will leverage industry expertise to identify market opportunities, design network-based pricing, and implement affordability solutions while maintaining member access and regulatory compliance.

The role requires 5+ years in related fields, with a Bachelor’s or advanced degree; seven+ years can substitute for a degree.