Sr. Director, Pharmacy - Prior Authorization & Call Center

Blue Shield of CA; Virginia Beach (VA); Hybrid; USD 210,000 - 300,000; Full time

Job summary

Blue Shield of California is seeking a Senior Director, Pharmacy Prior Authorization and Call Center to lead design, execution, and optimization of prior authorization and call center processes. You will manage a large team and partner with the Medical Director to ensure clinically appropriate, cost-effective patient care across pharmacy and medical benefits.

We value strategic thinking, data-driven improvements, and strong vendor management as part of delivering affordable access to medications

Qualifications

• Requires active California RPh license.
• Requires PharmD from an accredited U.S. school of pharmacy.
• Requires 12 years of prior experience in managed care health plans or PBM.
• Requires 6 years of people management experience.
• Vendor management experience preferred.
• Knowledge of pharmacy benefits, formulary, and networks preferred.

Responsibilities

• Design, execute, and optimize prior authorization and call center processes to ensure clinically appropriate, cost-effective patient care.
• Lead a team of 200+ employees and collaborate with Medical Director and vendors to improve access and affordability.
• Develop and implement strategic operational plans to improve efficiency and cost outcomes.
• Foster cross-functional collaboration and ensure regulatory and compliance adherence.

Skills

RPh license

Pharmacist leadership

12+ years exp

People management

Vendor management

Pharmacy benefits knowledge

Data-driven

Communication skills

Strategic thinking

Education

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 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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