Senior Strategy Advisor, Specialty Pharmacy Network

Blue Cross and Blue Shield of North Carolina; Wisconsin; 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 is seeking a senior strategic professional to help achieve pharmacy affordability goals through specialty network design, contracting strategy, network optimization, and market-based pricing approaches. You will evaluate opportunities, develop cost-reduction strategies, and communicate clear recommendations to senior leadership.

Responsibilities include developing network strategies, supporting planning and analysis, and collaborating across departments to advance affordability

Qualifications

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

Responsibilities

• Identify, analyze, evaluate, and implement specialty pharmacy network strategies, reimbursement models, and contracting opportunities that support affordability goals while maintaining member access, provider relationships, and regulatory compliance.
• Develop and execute specialty pharmacy network optimization strategies, including network design, performance management, pricing approaches, participation requirements, and market-based reimbursement methodologies.
• Support strategic planning, structured financial and qualitative analysis, business case development, and network evaluations to inform contracting decisions, network investments, and affordability initiatives.
• Translate complex network, reimbursement, and market dynamics into clear strategic recommendations and actionable plans for internal stakeholders, including senior leadership.
• Present network strategies, performance metrics, affordability opportunities, contracting recommendations, and impact assessments to internal audiences at all levels, including executive leadership.
• Collaborate with and support other departments across the enterprise on both common initiatives and unique ventures, acting as a subject matter expert in specialty pharmacy network strategy, contracting, reimbursement methodologies, and affordability solutions.
• Identify, analyze, and monitor industry, regulatory, technology, provider, PBM, and market trends that influence specialty pharmacy network performance, reimbursement economics, access models, and overall cost management.
• Engage with specialty pharmacies, PBMs, vendor, consultants, vendors, providers, and other external partners to evaluate opportunities, resolve strategic challenges, and support development of innovative affordability solutions.
• Organize, synthesize, and communicate progress, recommendations, and outcomes across the specialty pharmacy network strategy portfolio to support alignment, accountability, and informed decision‑making.
• Utilize expertise to advance network strategy, contracting, reimbursement, and affordability capabilities, continuously improving how network-based solutions are developed, evaluated, and implemented to achieve sustainable unit cost reduction.

Skills

Healthcare Consulting

Healthcare Financial Management

Healthcare Industry

Healthcare Innovation

Healthcare Management

Healthcare Reimbursement

Healthcare Strategic Planning

Health Outcomes

Medical Reimbursement

Performance Metrics

Physician Reimbursement

Project Management

Provider Reimbursement

Reimbursement

Reporting and Analysis

Education

Bachelor's degree or advanced degree

Job description

Blue Cross NC is seeking a senior strategic professional to help achieve pharmacy affordability goals through specialty network design, contracting strategy, network optimization, and market-based pricing approaches. You will evaluate opportunities, develop cost-reduction strategies, and communicate clear recommendations to senior leadership.

Responsibilities include developing network strategies, supporting planning and analysis, and collaborating across departments to advance affordability