Director, Specialty Pharmacy and Cost of Health Care Blue Shield of California - 3.6 Long Beach, CA Job Details Full-time $181,830 - $272,800 a year 14 hours ago Benefits Work from home Qualifications Registered Pharmacist (RPh) Vendor relationship building Managed care organization experience Health insurance policy knowledge Presentations for conferences or internal meetings Licensed Pharmacist (State-Specific) Doctor of Pharmacy Licensed Pharmacist Financial acumen Senior leadership Full Job Description Your Role The Blue Shield of California (BSC) Pharmacy team comprises of over 350 dedicated professionals who are passionate about making a meaningful impact by reimagining pharmacy care. Ensuring every member has safe, equitable access to sustainably affordable pharmacy benefits is at the heart of everything we do. The Director, Pharmacist (Specialty Pharmacy and Cost of Health Care) will report to the Senior Vice President/Chief Pharmacy Officer. In this role, you will drive strategies and performance of pharmacy Cost of Health Care (COHC) programs to manage annual pharmacy benefit costs for over $5 billion. You will lead your team to work cross functionally and partner with vendors as appropriate to develop and implement end-to-end strategies and differentiating solutions in both pharmacy and medical benefits for Commercial and Medicare. You will also own and drive the Specialty drug management program including management of cell and gene therapies. Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow - personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning. Your Work In this role, you will: Oversee a team of pharmacists and program managers Own end-to-end Specialty Drug Management Program for specialty drugs covered under pharmacy and medical benefits to yield sustainable affordability Partner with network teams to contract and reimburse differently (e.g. acquisition cost based, ASP based, provider fee schedule, etc.) with medical and pharmacy network providers Partner with clinical and benefit product teams to optimize program strategies and effectiveness Negotiate and provide oversight and direct management of select specialty vendor contracts and outcomes Support evaluation of manufacturer partnership programs and contracting opportunities (e.g. rebates, outcomes-based contracts) Lead development and implementation of COHC initiative roadmap by lines of business (LOB) to meet trend and financial targets for Commercial and Medicare Partner with pharmacy analytics and LOB teams to proactively evaluate pharmacy trend drivers, evaluate program ROI, drive end-to-end COHC strategy and program design for pharmacy and medical benefit drug spend Lead implementation of select initiatives to support Pharmacy Care Reimagined and biosimilars adoption Evaluate emerging vendor solutions and partnership opportunities and support contract development and negotiation Build a high performing team and foster a great workplace to do meaningful work Your Knowledge and Experience Requires a currently active and unrestricted California Registered Pharmacist (RPh) license Requires a Doctor of Pharmacy (PharmD) degree from an accredited school of pharmacy in the U.S. Requires at least 10 years prior relevant experience, including evaluation of pharmacy program value and performance drivers Requires 6 years of management experience in health plans or pharmacy benefit management companies, with deep knowledge of pharmacy benefit, formulary and network products, program strategies and competitive landscape Requires excellent communication skills with prior experience in presentations to internal and external executive level business stakeholders Prior experience in vendor partnership, contract operations, negotiations, and performance management is preferred Strong business acumen with proven experience in pharmacy strategy development and planning Excellent presentation, verbal and written skills with ability to understand and convey complex ideas to audience with diverse backgrounds Detail-oriented with the ability to work in a fast-paced environment Exhibit a "can do" attitude and solution-oriented approach to resolve challenges Hybrid This role requires employees to be in-office based on our hybrid workplace model, balancing purposeful in-person collaboration with flexibility. For most teams, this means coming into 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. #

LI-JS1 ABOUT THE TEAM

About Blue Shield of California As of January 2025, Blue Shield of California became a subsidiary of Ascendiun. Ascendiun is a nonprofit corporate entity that is the parent to a family of organizations including Blue Shield of California and its subsidiary, Blue Shield of California Promise Health Plan; Altais, a clinical services company; and Stellarus, a company designed to scale healthcare solutions. Together, these organizations are referred to as the Ascendiun Family of Companies. At Blue Shield of California, our mission is to create a healthcare system worthy of our family and friends and sustainably affordable. We are transforming health care in a way that genuinely serves our nonprofit mission by lowering costs, improving quality, and enhancing the member and physician experience. To achieve our mission, we foster an environment where all employees can thrive and contribute fully to address the needs of the various communities we serve. We are committed to creating and maintaining a supportive workplace that upholds our values and advances our goals. Blue Shield is a U.S. News Best Company to work for, a Deloitte U.S. Best Managed Company and a Top 100 Inspiring Workplace. We were recognized by Fair360 as a Top Regional Company, and one of the 50 most community-minded companies in the United States by Points of Light. Here at Blue Shield, we strive to make a positive change across our industry and communities - join us!

Our Values:

Honest. We hold ourselves to the highest ethical and integrity standards. We build trust by doing what we say we're going to do and by acknowledging and correcting where we fall short. Human. We strive to listen and communicate effectively, showing empathy by understanding others' perspectives. Courageous. We stand up for what we believe in and are committed to the hard work necessary to achieve our ambitious goals. Our Workplace Model We believe in fostering a workplace environment that balances purposeful in-person collaboration with flexibility - providing clear expectations while respecting the diverse needs of our workforce. Our workplace model is designed around intentional in-person interaction, collaboration, connection, creativity and flexibility: For most teams, this means coming into the office two days per week. Employees living more than 50 miles from an office location, out of state employees, and employees in certain member-facing roles should work with their manager to determine in-office time based on business need. For employees with medical conditions that may impact their ability to work in-office, we are committed to engaging in an interactive process and providing reasonable accommodations to ensure their work environment is conducive to their success and well-being. The Company reserves the right to require more presence in the office based on business needs, and requirements are subject to change with periodic reviews.

Physical Requirements:

Office Environment - roles involving part to full time schedule in Office Environment. Based in our physical offices and work from home office/deskwork - Activity level: Sedentary, frequency most of work day.

Equal Employment Opportunity:

External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.