Director, Pharmacy Strategy and Performance

Your Role

The Blue Shield of California (BSC) Pharmacy team comprises of over 350 dedicated professionals who are 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 Director, Pharmacist - Strategy and Performance will report to the Vice President, Pharmacy Performance at BSC. In this role, you will lead a team responsible for developing and executing enterprise pharmacy strategy across the pharmacy and medical benefits. You will oversee drug and network contracting, contract performance, and financial performance across provider-administered drugs, home infusion, and retail and specialty pharmacy networks. Additionally, you will partner closely with Pharmacy Clinical Leadership, Medical Management, Finance, Actuary, Provider Contracting, and external pharmacy benefit management (PBM) partners to identify and implement strategies that improve drug trend management and maximize value for members, clients, and the organization.

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 currently 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 10 years of prior relevant experience in a managed care health plan or pharmacy benefit management company or other relevant settings
• Requires 6 years of prior people management experience with direct responsibility for supervising, coaching, and evaluating direct reports
• Requires excellent communication skills with prior experience in presentations to internal and external executive level business stakeholders
• Knowledge of pharmacy benefits, formulary, network programs for drugs covered in pharmacy and medical benefits
• Prior experience in vendor partnership, contract operations, negotiations, and performance management is preferred
• Strong business acumen with proven experience in pharmacy strategy development and planning
• Excellent presentation, verbal and written skills with ability to understand and convey complex ideas to audience with diverse backgrounds
• Detail-oriented with the ability to work in a fast-paced environment
• Exhibit a "can do" attitude and solution-oriented approach to resolve challenges

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.

Your Work

In this role, you will:

• Lead development and execution of pharmacy affordability and value-based strategies across both pharmacy and medical drug spend understanding industry trends, market dynamics, regulatory changes, and competitive landscape
• Evaluate industry trends, market dynamics, and competitive landscape to help inform strategic decisions
• Own enterprise drug contracting strategy across the pharmacy and medical benefits, including manufacturer agreements, rebate contracting, value-based and outcomes-based arrangements, financial guarantees, and related contract performance
• Lead contracting and affordability strategies for drugs covered under the medical benefit, including provider-administered drugs and specialty therapies, in partnership with Provider Contracting and Network Management
• Design and implement reimbursement and site-of-care strategies that promote delivery in clinically appropriate, cost-effective settings
• Establish strategic direction, contracting requirements, and performance oversight for pharmacy and medical benefit networks, including retail, specialty pharmacy, home infusion, mail order, ancillary pharmacy, and provider networks supporting provider-administered drugs
• Monitor financial, operational, access, and quality performance through key performance indicators and contractual guarantees and evaluate emerging network designs and alternative drug distribution models
• Develop business cases and financial models supporting pharmacy strategic initiatives monitoring pharmacy trend, rebate performance, medical drug spend, and network economics
• Utilize data analytics to evaluate utilization patterns, identify savings opportunities, and measure program effectiveness
• Present performance results and strategic recommendations to senior leadership and executive stakeholders
• Build strong partnerships with internal stakeholders, PBM leadership, providers, pharmaceutical manufacturers, and industry organizations

Your Work

In this role, you will:

• Lead development and execution of pharmacy affordability and value-based strategies across both pharmacy and medical drug spend understanding industry trends, market dynamics, regulatory changes, and competitive landscape
• Evaluate industry trends, market dynamics, and competitive landscape to help inform strategic decisions
• Own enterprise drug contracting strategy across the pharmacy and medical benefits, including manufacturer agreements, rebate contracting, value-based and outcomes-based arrangements, financial guarantees, and related contract performance
• Lead contracting and affordability strategies for drugs covered under the medical benefit, including provider-administered drugs and specialty therapies, in partnership with Provider Contracting and Network Management
• Design and implement reimbursement and site-of-care strategies that promote delivery in clinically appropriate, cost-effective settings
• Establish strategic direction, contracting requirements, and performance oversight for pharmacy and medical benefit networks, including retail, specialty pharmacy, home infusion, mail order, ancillary pharmacy, and provider networks supporting provider-administered drugs
• Monitor financial, operational, access, and quality performance through key performance indicators and contractual guarantees and evaluate emerging network designs and alternative drug distribution models
• Develop business cases and financial models supporting pharmacy strategic initiatives monitoring pharmacy trend, rebate performance, medical drug spend, and network economics
• Utilize data analytics to evaluate utilization patterns, identify savings opportunities, and measure program effectiveness
• Present performance results and strategic recommendations to senior leadership and executive stakeholders
• Build strong partnerships with internal stakeholders, PBM leadership, providers, pharmaceutical manufacturers, and industry organizations