Sr. Director, Pharmacy - Prior Authorization & Call Center

Blue Shield of CA; Miami (FL); Hybrid; USD 250,000 - 360,000; Full time

Job summary

Blue Shield of California is seeking a Senior Director of Pharmacy Prior Authorization and Call Center to lead a large, mission-driven team in delivering clinically appropriate and cost-effective pharmacy and medical benefits. The role reports to the Senior VP of Pharmacy Services and requires leadership of over 200 staff, with a strong emphasis on performance, collaboration, and patient access.

Ideal candidates will bring extensive PBM/managed care experience, specialized pharmacy know-how, and

Qualifications

• Current active and unrestricted California Registered Pharmacist (RPh) license is required.
• Doctor of Pharmacy (PharmD) degree from a U.S. accredited school is required.
• 12 years in a managed care health plan or PBM or equivalent; and experience in prior authorization and call center operations.
• 6 years of people management with direct reports responsibility.
• Vendor management and oversight experience preferred.
• Therapeutic drug knowledge and familiarity with national guidelines preferred.
• Knowledge of pharmacy benefits, formulary, and network programs for PH/medical benefits preferred.
• Strong financial and business acumen with data-driven decision making.
• Excellent interpersonal, written, and verbal communication; strategic and analytic problem solving.

Responsibilities

• Design, execute, and optimize prior authorization and call center processes to ensure appropriate and cost-effective patient care.
• Lead and develop a team of 200+ employees, ensuring performance and accountability.
• Collaborate cross-functionally and with vendors to improve patient access to medications.
• Partner with Medical Director and senior leadership to align operations with business goals.

Skills

Leadership experience

Analytical thinking

Strategic thinking

Communication skills

Vendor management

Financial acumen

Team management

Pharmacy knowledge

Education

PharmD degree

CA RPh license

Job description

Your Role

The Blue Shield of California (BSC) Pharmacy team is passionate about making a meaningful impact by reimagining pharmacy care. Ensuring every member has safe, equitable access to sustainably affordable pharmacy benefits is at the heart of everything we do. The Senior Director, Pharmacy Prior Authorization and Call Center will report to the Senior Vice President of Pharmacy Services at BSC. In this role you will manage a team of over 200 employees and in collaboration with the Medical Director, be responsible for designing, executing, and optimizing prior authorization and call center processes to ensure clinically appropriate, cost effective, and compliant patient care. You will work cross functionally and partner with vendors as appropriate to optimize patient access while supporting affordability of medications covered under pharmacy and medical benefits for all lines of businesses.

Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow - personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.

Your Knowledge and Experience

• Requires a current active and unrestricted California Registered Pharmacist (RPh) license
• Requires a Doctor of Pharmacy (PharmD) degree from an accredited school of pharmacy in the U.S.
• Requires 12 years of prior experience in: a managed care health plan or pharmacy benefit management companies or other relevant settings; pharmacy prior authorization program and call center operations; developing and implementing strategic operational plans to optimize efficiency and cost outcomes
• Requires 6 years of prior people management experience with direct responsibility for supervising, coaching, and evaluating direct reports
• Prior experience in vendor management and oversight preferred
• Thorough knowledge regarding therapeutic use of drugs and available national guidelines preferred
• Knowledge of pharmacy benefits, formulary, network programs for drugs covered in pharmacy and medical benefits preferred
• Strong financial and business acumen with the ability to leverage performance data to drive operational improvements
• Excellent interpersonal, written & verbal communication skills
• Strategic and analytic thinking; problem-solving skills informed by data and evidence
  

Hybrid

This role requires employees to be in-office based on our hybrid workplace model, balancing purposeful in-person collaboration with flexibility. For most teams, this means coming into the office two days each week.

Employees living more than 50 miles from an office location will work with their manager to determine in-office time based on business need.

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