Strategic Lead, Pharmacy Prior Authorization & Call Center

Blue Shield of CA; Atlanta (GA); Hybrid; USD 210,000 - 320,000; Full time

Job summary

Blue Shield of California (BSC) is seeking a Senior Director, Pharmacy Prior Authorization and Call Center on the Pharmacy Services team. You will design, execute, and optimize prior authorization and call center processes to ensure proper, affordable patient care.

You will lead a team of 200+ and partner with the Medical Director to drive cost-effective outcomes. The role emphasizes cross-functional collaboration, vendor management, and strategic leadership, with a hybrid in-office schedule

Qualifications

• Active California RPh license required.
• PharmD from an accredited U.S. school required.
• 12 years in managed care, PBM, or related settings with prior authorization and call center operations.
• 6 years of people management experience supervising and evaluating staff.
• Vendor management experience preferred.
• Knowledge of therapeutic drug use and national guidelines preferred.
• Knowledge of pharmacy benefits, formulary and network programs preferred.
• Strong financial and business acumen to drive improvements.
• Excellent interpersonal and written/verbal communication.
• Strategic and analytic thinking with data-driven problem solving.

Responsibilities

• Design, execute, and optimize prior authorization and call center processes.
• Collaborate cross-functionally with stakeholders and vendors.
• Lead and develop a team of 200+ employees.
• Drive clinically appropriate, cost-effective, and compliant patient care.

Skills

Strategic thinking

Analytical thinking

Problem solving

Communication skills

Financial acumen

Interpersonal skills

Education

Doctor of Pharmacy (PharmD) degree

California Registered Pharmacist (RPh) license

Job description

Blue Shield of California (BSC) is seeking a Senior Director, Pharmacy Prior Authorization and Call Center on the Pharmacy Services team. You will design, execute, and optimize prior authorization and call center processes to ensure proper, affordable patient care.

You will lead a team of 200+ and partner with the Medical Director to drive cost-effective outcomes. The role emphasizes cross-functional collaboration, vendor management, and strategic leadership, with a hybrid in-office schedule