Sr. Director, Pharmacy - Prior Authorization & Call Center

Blue Shield of CA; Redding (CA); Hybrid; USD 180,000 - 250,000; Full time

Job summary

The Blue Shield of California Pharmacy team is focused on delivering safe, equitable access to affordable pharmacy benefits. The Senior Director, Pharmacy Prior Authorization and Call Center will guide PA and call center operations, ensuring clinical appropriateness, cost effectiveness, and regulatory compliance across all lines of business.

You will lead a large, cross-functional team, partnering with the Medical Director and external vendors to optimize patient access while managing overall

Qualifications

• Must hold a current, active CA RPh license.
• Must hold a Doctor of Pharmacy (PharmD) degree from a US-accredited school.
• Requires 12 years in managed care/PBM or related roles; prior authorization and call center operations; optimizing efficiency and cost outcomes.
• Requires 6 years of people management experience.
• Vendor management experience preferred.
• Knowledge of drug therapeutics and national guidelines preferred.
• Knowledge of pharmacy benefits, formulary, network programs for pharmacy/medical benefits preferred.
• Strong financial and business acumen with the ability to leverage performance data.
• Excellent interpersonal, written & verbal communication skills.
• Strategic and analytic thinking; data-driven problem solving.

Responsibilities

• Design, execute, and optimize prior authorization and call center processes to ensure clinically appropriate, cost effective patient care.
• Lead a team of over 200 employees in collaboration with the Medical Director.
• Partner with vendors to optimize patient access while supporting affordability of medications covered under pharmacy and medical benefits.

Skills

Leadership

Communication skills

Analytical thinking

Financial acumen

Vendor management

Strategic thinking

Education

Doctor of Pharmacy (PharmD)

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 people management experience
• 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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