Senior Director, Pharmacy Programs

Blue Cross Blue Shield Association

4d•Hybrid

About The Position

This role encompasses the management and oversight of drug utilization and expenditure within the Pharmacy and Medical benefits. It involves the operational management of the Federal Employee Program's Employer Group Waiver Plan and Medicare Part D, collaborating with key stakeholders including pharmacy benefit managers, executives, and staff for contract administration. The position leads the FEP Pharmacy and Medical Policy Committee, supports the National Pharmacy & Therapeutic Committee, and maintains relationships with key Federal government agencies. It also involves directing medical drug policy development, managing pharmaceutical manufacturer engagement, and acting as a clinical expert for the pharmacy team. Additionally, it includes working on medical benefit drug implementations and pilot projects. Leads the overall management and strategic direction for the pharmacy program including Medicare Part D/EGWP program. Identifying new opportunities for optimal drug benefit control, analyzing utilization and pricing across medical and pharmacy benefits, developing tools to manage drug expenditure while maintaining clinical excellence, and presenting recommendations to senior leadership. Manages the pipeline, assessing the potential impact on the formulary and medical drug benefit, strategizing manufacturer engagement before and after product launch, and overseeing internal processes for Pharmacy and Therapeutics Committee and the National Pharmacy & Therapeutics meeting preparations, execution, and formulary status decisions. Lead internal & external presentations for national forums, Operations Conferences and Plan level presentations. Work collaboratively with key stakeholders to identify best practices for management of the drugs under the Medical Benefit. Work cross-functionally to determine process implications of suggested new programs and the operational implementation of initiatives under the medical benefit. Lead and manage a team with the aim of driving effective performance management, fostering professional growth, and creating a positive and inclusive work environment. This role is dedicated to utilizing strong leadership and communication skills to motivate and inspire team members, ensuring they are aligned with and committed to achieving the organization’s goals.

Requirements

Bachelor's Degree in pharmacy
12+ Years experience in Managed Care Pharmacy or Pharmacy Benefit Management (PBM) experience with an emphasis on Specialty drug management
Solid communication skills
Strong Interpersonal skills
Proven proficiency with applicable information technologies
Analytical skills: ability to perform financial analysis on new products and services as well as basic SWOT analysis
PHARMD - Licensed Pharmacist - Various

Nice To Haves

Doctor of Pharmacy
Master's Degree
Clinical advanced degree (various fields)
Advanced degree in Business (MBA)
Experience in a senior leadership role.

Responsibilities

Management and oversight of drug utilization and expenditure within Pharmacy and Medical benefits.
Operational management of the Federal Employee Program's Employer Group Waiver Plan and Medicare Part D.
Collaboration with pharmacy benefit managers, executives, and staff for contract administration.
Leading the FEP Pharmacy and Medical Policy Committee and supporting the National Pharmacy & Therapeutic Committee.
Maintaining relationships with key Federal government agencies.
Directing medical drug policy development and managing pharmaceutical manufacturer engagement.
Acting as a clinical expert for the pharmacy team.
Working on medical benefit drug implementations and pilot projects.
Leading the overall management and strategic direction for the pharmacy program including Medicare Part D/EGWP program.
Identifying new opportunities for optimal drug benefit control, analyzing utilization and pricing across medical and pharmacy benefits, developing tools to manage drug expenditure while maintaining clinical excellence, and presenting recommendations to senior leadership.
Managing the pipeline, assessing the potential impact on the formulary and medical drug benefit, strategizing manufacturer engagement before and after product launch, and overseeing internal processes for Pharmacy and Therapeutics Committee and the National Pharmacy & Therapeutics meeting preparations, execution, and formulary status decisions.
Lead internal & external presentations for national forums, Operations Conferences and Plan level presentations.
Work collaboratively with key stakeholders to identify best practices for management of the drugs under the Medical Benefit.
Work cross-functionally to determine process implications of suggested new programs and the operational implementation of initiatives under the medical benefit.
Lead and manage a team with the aim of driving effective performance management, fostering professional growth, and creating a positive and inclusive work environment.