Sr Strategic Advisor, Specialty Pharmacy Networks

Blue Cross and Blue Shield of North Carolina; Northern (KY); Hybrid; USD 89,000 - 143,000; Full time

Benefits offered by this job

Annual Incentive Bonus

401(k) with employer match

Paid Time Off

Job summary

Blue Cross NC seeks a senior member of the strategic function to advance specialty pharmacy network design, contracting strategy, and affordability initiatives. The role analyzes market opportunities, optimizes networks, and develops cost-reduction strategies while ensuring member access and regulatory compliance.

You will present strategic recommendations to senior leadership, collaborate across departments, monitor regulatory and market trends, and drive affordable solutions with external

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

Skills

Healthcare consulting

Financial management

Healthcare industry

Healthcare management

Healthcare reimbursement

Performance metrics

Provider reimbursement

Project management

Reimbursement

Healthcare strategic planning

Health outcomes

Education

Bachelor's degree

Job description

Job Description Acts as a senior member of the strategic function by contributing to the achievement of pharmacy affordability goals through specialty pharmacy network design, contracting strategy, network optimization, and innovative market-based pricing approaches. Leverages industry experience and expertise to evaluate emerging market opportunities, develop and implement network-based cost reduction strategies, and promote enterprise understanding of specialty pharmacy market dynamics to create sustainable competitive advantage and long-term affordability improvements. 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 specialty pharmacy 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.

Hiring Requirements

• 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.

Salary Range At Blue Cross NC, we take great pride in a fair and equitable compensation package that reflects market-price and our starting salaries are typically planned near the middle of the range listed. Compensation decisions are driven by factors including experience and training, specialized skill sets, licensure and certifications and other business and organizational needs. Our base salary is part of a robust Total Rewards package that includes an Annual Incentive Bonus*, 401(k) with employer match, Paid Time Off (PTO), and competitive health benefits and wellness programs. *Based on annual corporate goal achievement and individual performance. $89,174.00 - $142,679.00

Skills

Healthcare Consulting, Healthcare Financial Management, Healthcare Industry, Healthcare Innovation, Healthcare Management, Healthcare Reimbursement, Healthcare Strategic Planning, Health Outcomes, Medical Reimbursement, Performance Metrics, Physician Reimbursement, Project Management, Provider Reimbursement, Reimbursement, Reporting and Analysis

About Us

It's an exciting time to work at Blue Cross and Blue Shield of North Carolina (Blue Cross NC). Health care is changing, and we're leading the way. We offer more than health insurance our customers can count on. We’re committed to better health and better health care - in our communities and beyond. Our employees bring energy and creativity to the workplace, and it shows in our innovative approach to improving the health and well-being of North Carolinians. Blue Cross NC is a fully taxed, not-for-profit company headquartered in Durham, North Carolina. We serve more than 4.3 million members, and we employ more than 5,000 people across the country who are passionate about making health care better for all. Help us lead the charge for better health care by joining our award-winning team. Discover tremendous opportunities with us to do challenging and rewarding work. Opportunities that can lead you to a fulfilling career, work that can help others lead healthier, happier lives.

Authorization to Work in the United States

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Request Accommodations

Blue Cross NC provides reasonable accommodations to applicants with disabilities. If you need a reasonable accommodation for any part of the application or hiring process, please notify HR at [e-mail].

Blue Cross NC is a Hybrid Flex company. Whether the role is Hybrid Flex or Remote Flex depends on the nature of the work and distance from our Durham headquarters. We welcome candidates from outside the local area and in any of our approved states: Alabama, Arizona, Arkansas, Colorado, Florida, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Michigan, Mississippi, Missouri, North Carolina, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Wisconsin, and Wyoming