Sr. Manager, Pharmacist (Formulary/PBM)

Blue Shield of CA; Oakland (CA); Hybrid; USD 150,000 - 190,000; Full time

Job summary

Blue Shield of CA is seeking a Senior Manager, Pharmacist of Formulary Management to lead a team of pharmacists and operations specialists across CMS/Medicare formulary submissions, SERFF filings, and UM processes.

You will partner with analytics, product, actuary, and operations to develop strategies that improve affordability, quality, compliance, and member experience, while meeting regulatory requirements in US markets.

Qualifications

• Doctor of Pharmacy (PharmD) degree from an accredited school of pharmacy in the US.
• Active and unrestricted California Registered Pharmacist (RPh) license.
• At least 8 years of managed care pharmacy experience.
• 4 years of people management experience with direct responsibility for supervising, coaching, and evaluating direct reports.
• Experience with Medicare, ACA, Exchange, CMS/Medicare formulary and UM submissions, SERFF submissions, and other applicable regulatory requirements.
• Demonstrated ability to lead formulary and UM processes, projects, timelines, and cross-functional implementation activities.
• Strong independent judgment, analytical thinking, problem-solving skills, and ability to use data to drive decisions and results.
• Thorough knowledge of managed care and pharmacy benefit management practices, including UM.
• Advanced proficiency with Microsoft Office applications, including Excel, Access, and PowerPoint.

Responsibilities

• Lead a team of pharmacists and operations specialists responsible for formulary operations, CMS/Medicare formulary and UM submissions, SERFF submissions, formulary and UM implementation and adjudication accuracy.
• Partner with analytics, product, actuary, operations, vendors, and other business partners to develop and execute strategies that improve affordability, quality, compliance, and member experience.
• Contribute to the development and execution of strategies to support competitive health plan products and regulatory requirements.
• Provide leadership that develops great leaders at all levels and fosters continuous learning.

Skills

PharmD

California RPh

Managed care

People management

CMS/Medicare submissions

SERFF

Regulatory compliance

Data-driven decisions

MS Office

Analytical thinking

Education

PharmD degree

California Pharmacist License

Job description

Your Role

The Formulary Strategy and Management team develops and maintains formularies that support competitive health plan products, manage health care costs, and meet regulatory requirements across Commercial Large Group, Commercial Small Group, Individual/Family, and Medicare lines of business. The Senior Manager, Pharmacist of Formulary Management reports to the Director, Formulary Strategy and Pharmacy & Therapeutics.

In this role, you will lead a team of pharmacists and operations specialists responsible for formulary operations, Centers for Medicare & Medicaid Services (CMS)/Medicare formulary and utilization management (UM) submissions, System for Electronic Rates and Forms Filing (SERFF) submissions, formulary and UM implementation and adjudication accuracy. You will partner with analytics, product, actuary, operations, vendors, and other business partners to develop and execute strategies that improve affordability, quality, compliance, and member experience.

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

• Doctor of Pharmacy (PharmD) degree from an accredited school of pharmacy in the US.
• Active and unrestricted California Registered Pharmacist (RPh) license
• At least 8 years of managed care pharmacy experience
• 4 years of people management experience with direct responsibility for supervising, coaching, and evaluating direct reports
• Experience with Medicare, ACA, Exchange, CMS/Medicare formulary and UM submissions, SERFF submissions, and other applicable regulatory requirements
• Demonstrated ability to lead formulary and UM processes, projects, timelines, and cross-functional implementation activities
• Strong independent judgment, analytical thinking, problem-solving skills, and ability to use data to drive decisions and results
• Thorough knowledge of managed care and pharmacy benefit management practices, including UM
• Advanced proficiency with Microsoft Office applications, including Excel, Access, and PowerPoint

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.