Reporting to the Senior Director, Pharmacy Services, the role of the Principal Pharmacist, Pharmacy Markets Performance is critical to the success of Blue Shield of California and the Pharmacy Services department in realizing its goals and objectives. This individual will play a key role as part of Pharmacy Markets, Analytics, Products and Strategies area in leading and collaborating cross-functionally with key stakeholders across Blue Shield to evaluate pharmacy performance by lines of business and provide consultations and program recommendations to optimize pharmacy performance by lines of business to support affordability and membership growth objectives. Pharmacy performance may include network, rebate, drug mix, and PBM contract management opportunities to reduce cost of health care, administrative costs and enhance revenue.
The individual may be based in our Oakland, Rancho Cordova, Woodland Hills office or may telecommute. Due to COVID-19 impact and current guidelines, the Principal Pharmacist will onboard and work remotely until Blue Shield resumes work in its office, no earlier than mid-2021.
Responsibilities
Lead review of pharmacy cost, utilization, and finance data to identify opportunities to optimize pharmacy performance on cost and revenue.
Work cross functionally as appropriate to validate opportunities and support initiative roadmap planning by lines of business.
Participate in lines of business finance and performance review meetings to understand and/or provide input on business drivers and objectives.
Serve as a liaison to actuary and finance stakeholders to research and explain financial and trend variance.
Leverage various data sources and reports to create executive summaries and actionable plans to support performance management.
Provide pharmacy consultations and information as appropriate to support pharmacy product and pricing strategy, annual renewal and membership growth initiatives.
Partner with analytics team to leverage data repositories and reports to create and/or enhance pharmacy dashboard to support performance monitoring.
Drive data requirements and cost studies to support opportunity identification and/or demonstrate Blue Shield program value proposition.
Support strategic initiative and innovation planning and lead select initiative implementation as assigned.
Pharmacist with pharmacy benefit management and managed health plan operational experience required.
Excellent analytic skills with ability to leverage business knowledge to interpret pharmacy financial data and derive actionable recommendations as appropriate.
Strong business acumen with understanding of pharmacy management levers, benefits, and regulations for Medicare, and expertise in Commercial, Exchange and/or Medicaid is preferred.
Demonstrated ability to work independently and collaboratively with multi-disciplinary teams with minimal oversight and direction from the manager required.
Possesses excellent presentation, verbal, and written skills with ability to understand and convey complex ideas to audience with diverse backgrounds required.
Robust sense of ownership, accountability, and responsibility required.
Knowledge and Experience
Pharm.D. degree and 4 or more years of work experience in managed care or PBM settings required.
Currently active unrestricted California Registered Pharmacist (R.Ph.) license required.
Prior experience in pharmacy benefit management operations and demonstrated ability to interpret pharmacy benefit utilization and financial data is required.
Possesses strong business acumen with proven experience in thinking strategically required.
Strong data analytic and data management skills with ability to perform analysis using summarized and/or detail claim information.
Demonstrated ability to successfully work with other functional departments within a health plan is required.
Possesses excellent verbal and written skills with ability to convey and understand complex ideas.
Must be proficient in MS Office, particularly MS Word, PowerPoint, and Excel
Detail-oriented with the ability to work in a fast-paced environment.
Exhibits "can do" attitude and solution-oriented approach to resolve challenges preferred.
Able to work independently with minimum direction or supervision required.
Possesses strong collaboration and partnership skills in a matrixed work environment preferred.
Demonstrate ability to manage challenging situations in a positive and constructive manner.
Produces accurate work under tight deadlines.
Additional Information
About Company: At Blue Shield of California we are parents, leader, students, visionaries, heroes, and providers. Everyday we come together striving to fulfill our mission, to ensure all Californians have access to high-quality health care at a sustainably affordable price. For more than 80 years, Blue Shield of California has been dedicated to transforming health care by making it more accessible, cost-effective, and customer-centric. We are a not-for-profit, independent member of the Blue Cross Blue Shield Association with 6,800 employees, more than $20 billion in annual revenue and 4.3 million members. The company has contributed more than $500 million to Blue Shield of California Foundation since 2002 to have a positive impact on California communities. Blue Shield of California is headquartered in Oakland, California with 18 additional locations including Sacramento, Los Angeles, and San Diego. We're excited to share Blue Shield of California has received awards and recognition for - LGBT diversity, quality improvement, most influential women in corporate America, Bay Area's top companies in volunteering & giving, and one of the world's most ethical companies. Here at Blue Shield of California, we're striving to make a positive change across our industry and the communities we live in - Join us!
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. Please click here for further physical requirement detail.
EEO Footer: 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.
