Sr. Director, Pharmacy - Prior Authorization & Call Center

Blue Shield of California • Oakland, CA

2d • $212,630 - $359,476 • Hybrid

About The Position

The Senior Director, Pharmacy Prior Authorization and Call Center reports to the Senior Vice President of Pharmacy Services at Blue Shield of California. The role leads a team of more than 200 employees and, in collaboration with a Medical Director, designs, executes, and optimizes prior authorization and call center processes to support clinically appropriate, cost-effective, and compliant patient care. The position partners across functions and with vendors as appropriate to optimize patient access while supporting medication affordability across pharmacy and medical benefits and all lines of business.

The leader is expected to develop high-performing teams, support continuous learning, and deliver results in alignment with organizational leadership principles. The position operates under a hybrid workplace model: most teams work in the office two days each week. Employees living more than 50 miles from an office location determine in-office time with their manager based on business need. The role is based in an office and home-office/deskwork environment, with a sedentary activity level for most of the workday.

Requirements

• Current, active, and unrestricted California Registered Pharmacist (RPh) license.
• Doctor of Pharmacy (PharmD) degree from an accredited U.S. school of pharmacy.
• 12 years of prior experience in a managed care health plan, pharmacy benefit management company, or other relevant setting; pharmacy prior authorization program and call center operations; and development and implementation of strategic operational plans to optimize efficiency and cost outcomes.
• 6 years of prior people management experience, with direct responsibility for supervising, coaching, and evaluating direct reports.
• Strong financial and business acumen, including the ability to use performance data to drive operational improvements.
• Excellent interpersonal, written, and verbal communication skills.
• Strategic and analytical thinking and problem-solving skills informed by data and evidence.

Nice To Haves

• Prior experience in vendor management and oversight.
• Thorough knowledge of therapeutic drug use and available national guidelines.
• Knowledge of pharmacy benefits, formularies, and network programs for drugs covered under pharmacy and medical benefits.

Responsibilities

• Lead and manage the prior authorization team to meet clinical, regulatory, and business objectives of the prior authorization program.
• Lead and manage the pharmacy call center team in supporting inbound and outbound provider calls to coordinate access to appropriate drug therapy for members.
• Implement and maintain medication coverage policies for drugs covered under pharmacy and medical benefits, promoting evidence-based coverage decisions.
• Collaborate with analytics and business areas to evaluate prior authorization program outcomes and performance and identify improvement opportunities.
• Develop and implement prior authorization vendor oversight programs and processes to ensure compliance with expected clinical and regulatory standards.
• Collaborate with BSC Medical Directors, Appeals and Grievance, and care management teams to support evidence-based decision-making, adherence to coverage policies, care coordination, and customer experience.
• Implement strategies and technology enhancements, including automation and AI, to improve program effectiveness and operational efficiency.
• Participate in regulatory or quality audits involving review of the utilization management program.
• Build a high-performing team, promote leadership principles among managers, and foster a workplace where people can do meaningful work.

What This Job Offers

• Job Type: Full-time
• Career Level: Director
• Education Level: Ph.D. or professional degree