Senior Manager, Pharmacy
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Job Description
Senior Pharmacy Manager overseeing utilization management and clinical review teams for Blue Cross NC, a nonprofit health insurer. Driving compliant pharmacy programs, operational performance, and medication-therapy strategy.
Responsibilities:
- Oversee utilization management operations and clinical review teams for an assigned Commercial or Government line of business
- Develop and execute plans to achieve operational and quality targets
- Maintain relationships with stakeholders, internal and external partners, and vendors
- Promote collaboration across teams to leverage efficiencies, identify best practices, and drive implementation
- Represent team needs in budget planning and divisional and enterprise roadmaps, including technology and digital initiatives
- Serve as liaison between frontline staff, leadership, and cross-functional partners
- Direct clinical and non-clinical operational aspects of pharmacy utilization management services
- Support managers with prioritization, program monitoring, and corrective actions
- Monitor dependencies, performance, and vendor/PBM services; identify risks, remove barriers, and escalate issues
- Manage or support corporate and departmental projects affecting pharmacy utilization management operations and vendors
- Manage utilization management programs and policies to achieve trend targets, reduce medical expense, and ensure cost-effective operations
- Identify operational initiatives and process modifications to improve competitive position
- Ensure programs comply with State, Federal, and accrediting-body regulations and implement corrective action plans
- Evaluate pharmacy industry trends, best practices, challenges, and strategic needs to recommend and drive interventions and programs
- Participate in departmental strategic plans and objectives to improve performance, revenue development, and member and provider experience
- Provide clinical consultation on medication therapy and recommend utilization management strategies for traditional and specialty therapies
- Represent the Pharmacy department on committees, C-suite presentations, speaking engagements, PBM meetings, and customer meetings
Requirements:
- Bachelor's degree or advanced degree in Pharmacy
- 8+ years of experience in a related field
- In lieu of degree, 10+ years of experience in a related field
- Current pharmacy license required
- NC licensure may be needed for some roles
- Experience leading people and supporting career/professional development preferred
- Experience with culture and engagement support and interventions preferred
- Resource and budget management experience preferred
- Project planning and management experience preferred
- Authorization to work in the United States
Benefits:
- Work-life balance, flexibility, and autonomy
- Medical, dental, and vision coverage
- Health and wellness programs
- Parental leave and support
- Adoption and surrogacy assistance
- Career development programs
- Tuition reimbursement for continued education
- 401k match including an annual company contribution
- Annual Incentive Bonus based on annual corporate goal achievement and individual performance
- Paid Time Off (PTO)
- Reasonable accommodations for applicants with disabilities
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