Manager, Pharmacy Utilization Management

Premera Blue Cross•Mountlake Terrace, WA

19h•Hybrid

About The Position

The Manager, Pharmacy Utilization Management is a newly created leadership role that brings together clinical expertise and operational leadership to help shape the future of Pharmacy Utilization Management at Premera. The role connects the department’s strategic direction with the evolving needs of its review operations and supports a unified approach across pharmacy benefit and medical benefit drugs. The manager helps position Pharmacy UM for its next phase as workforce models, workflows, and technology evolve. The role oversees the team’s day-to-day work and supports clinical programs, operations, and consulting in delivering Premera’s Pharmacy Program strategy while meeting customer needs. Areas of focus may include drug utilization management and prior authorization across medical and pharmacy benefits; quality accreditation reporting and procedures; PBM and other vendor setup, testing, and issue resolution; specialty pharmacy setup and escalated customer issues; and formulary programs, promotions, and oversight of the Pharmacy and Therapeutics Committee. The manager is responsible for hiring, performance management, training, and professional development. The role also provides clinical training and business support to Sales and Marketing on pharmacy and medical management strategies and solutions, contributes to pharmacy and clinical/medical management content in RFPs, and completes special projects and other assigned duties. The position may be assigned internal controls under Premera’s internal controls framework; the manager is accountable for understanding those controls and their impacts and ensuring they operate effectively.

Requirements

Pharmacist with an advanced degree, such as PharmD, MBA, MHA, or MPH.
Active state Pharmacist License.
Six years of pharmacy experience, including at least two years focused in any combination of clinical program development, pharmacy consulting, work in a Pharmacy Benefit Management organization, or work in a health plan.
Demonstrated ability to lead and manage multiple complex, concurrent projects or teams.
Ability to communicate effectively verbally and in writing, with strong presentation skills.
Proven ability to build and maintain relationships with internal and external individuals.
Strong analytical skills and demonstrated experience analyzing trends and making recommendations based on analysis.
Working knowledge of local and regional healthcare issues.
Ability to work independently and as a member of a team.
Intermediate MS Word, Excel, PowerPoint, and Outlook skills.

Nice To Haves

Completion of an ASHP-accredited residency program.
Experience with project management.
Experience in managed care pharmacy.
LEAN program or process experience or certification, Six Sigma experience or certification, or experience or certification in another process improvement program.

Responsibilities

Oversee day-to-day team activities, including staff management, achievement of department goals, and team effectiveness.
Ensure clinical programs, operations, and consulting effectively deliver on the strategic direction of Premera’s Pharmacy Program while meeting customer needs.
Develop and maintain monitoring and ongoing improvement strategies for pharmacy clinical programs, operations, or consulting.
Oversee areas that may include drug utilization management and prior authorization across medical and pharmacy benefits; quality accreditation reporting, documentation, and required pharmacy procedures; PBM and other vendor setup, testing, and issue resolution; specialty pharmacy setup, testing, and escalated customer issues; and formulary programs and promotions, including the Pharmacy and Therapeutics Committee.
Hire, manage performance, train, and support the professional development of team members.
Provide clinical training and business support to Sales and Marketing on pharmacy and medical management strategies and solutions, including pharmacy benefit sales to current and prospective clients.
Contribute to and manage completion of pharmacy and clinical/medical management content in RFPs.
Complete special projects and other duties as assigned.
Understand assigned internal controls, their impacts on Premera, and ensure they operate effectively.

Benefits

Medical, vision, and dental coverage with low employee premiums.
Voluntary benefits, including pet insurance.
Life and disability insurance.
Retirement programs, including a 401(k) employer match and a pension plan vested after three years of service.
Wellness incentives and mental well-being resources, including counseling, stress management, and mindfulness programs.
Generous paid time off.
Tuition assistance for undergraduate and graduate degrees.
Employee recognition program.
Hybrid employees have access to on-campus resources, networking opportunities, and team engagement.
Commuter perks.
Free on-site parking.
Subsidized on-campus cafes.
On-site activities, including health and wellness events, coffee connects, and disaster preparedness fairs.
Fitness and well-being center with in-person and virtual workouts and nutritional counseling.
On-site shuffleboard and ping pong.