Director, Pharmacy Strategy and Performance

Blue Shield of California•Long Beach, CA

12d•Hybrid

About The Position

The Director, Pharmacy Strategy and Performance leads a team responsible for developing and executing enterprise pharmacy strategy across pharmacy and medical benefits. The role oversees drug and network contracting, contract performance, and financial performance for provider-administered drugs, home infusion, and retail and specialty pharmacy networks. The director partners with Pharmacy Clinical Leadership, Medical Management, Finance, Actuary, Provider Contracting, and external pharmacy benefit management (PBM) partners to improve drug trend management and maximize value for members, clients, and the organization. The position reports to the Vice President, Pharmacy Performance at Blue Shield of California. The role develops and executes affordability and value-based strategies; owns enterprise drug contracting strategy; leads medical-benefit drug contracting and affordability strategies; and establishes direction and performance oversight for pharmacy and medical benefit networks. It also develops financial models and business cases, uses analytics to assess utilization and savings opportunities, and presents results and recommendations to senior leaders. This is a hybrid role. For most teams, the model means working in 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.

Requirements

Currently active and unrestricted California Registered Pharmacist (RPh) license.
Doctor of Pharmacy (PharmD) degree from an accredited school of pharmacy in the United States.
10 years of prior relevant experience in a managed care health plan, pharmacy benefit management company, or other relevant setting.
6 years of prior people management experience with direct responsibility for supervising, coaching, and evaluating direct reports.
Excellent communication skills and experience presenting to internal and external executive-level business stakeholders.
Knowledge of pharmacy benefits, formulary, and network programs for drugs covered under pharmacy and medical benefits.
Strong business acumen and proven experience in pharmacy strategy development and planning.
Excellent presentation, verbal, and written skills, with the ability to understand and convey complex ideas to audiences with diverse backgrounds.
Detail-oriented with the ability to work in a fast-paced environment.
A can-do attitude and solution-oriented approach to resolving challenges.

Nice To Haves

Prior experience in vendor partnership, contract operations, negotiations, and performance management.

Responsibilities

Lead development and execution of pharmacy affordability and value-based strategies across pharmacy and medical drug spending, taking industry trends, market dynamics, regulatory changes, and the competitive landscape into account.
Evaluate industry trends, market dynamics, and the competitive landscape to inform strategic decisions.
Own enterprise drug contracting strategy across 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 for pharmacy strategic initiatives, monitoring pharmacy trend, rebate performance, medical drug spend, and network economics.
Use 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.