Senior Strategy Advisor: Specialty Pharmacy Networks

Blue Cross and Blue Shield of North Carolina

Georgia

On-site

USD 89,000 - 143,000

Full time

14 days+

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Job summary

Blue Cross NC in the United States seeks a Senior Specialist to shape specialty pharmacy network strategy and affordability. You will design networks, evaluate reimbursement models, and drive cost reductions while preserving member access and regulatory compliance.

You will partner with PBMs, providers, and other stakeholders, translate market dynamics into actionable plans for executive leadership, and support enterprise affordability initiatives through data-driven analysis and strategic

Qualifications

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

Responsibilities

Proactively 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 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.