Director, Pharmacy Benefits and Innovation

Awarded a Healthiest Employer, Blue Cross Blue Shield of Arizona aims to fulfill its mission to inspire health and make it easy. BCBSAZ offers a variety of health insurance products and services to meet the diverse needs of individuals, families, and small and large businesses as well as providing information and tools to help individuals make better health decisions.

This rwork opportunity requires residency, and work to be performed, within the State of Arizona.

Purpose of the job

• Exercises broad strategic and operational oversight for planning, organizing, and directing all aspects of pharmacy programs including commercial, exchange, Medicaid and other programs and compliance requirements, formulary design and maintenance, and pharmacy utilization / quality management. Acts as primary pharmacy, operations, and compliance liaison with designated pharmacy benefits manager (PBM). Oversee and manage PBM contract.

REQUIRED QUALIFICATIONS

Required Work Experience

• 7 years of experience in a PBM environment with expertise in drug pricing and contracting
• 5 years of experience in developing strategic plans, forecasting, and budgeting
• 5 years of experience in a leadership role at a health plan or managing health plans
• 5 years of progressively responsible administrative leadership in a healthcare setting

Required Education

• Bachelor’s degree in Pharmacy or Doctor of Pharmacy

Required Licenses

• Active, current, and unrestricted State of Arizona (a state in the United States) pharmacist license must be obtained within six months of placement in this role.

Required Certifications

• Registered Pharmacist

PREFERRED QUALIFICATIONS

Preferred Work Experience

• 10 years of experience in a PBM environment with expertise in drug pricing and contracting
• 10 years of management experience
• 5 years of experience in a leadership role at a health plan or managing health plans

Preferred Education

• Master’s degree in public health, healthcare administration, business administration, or related field

Preferred Licenses

• N/A

Preferred Certifications

• N/A

ESSENTIAL job functions AND RESPONSIBILITIES

• Direct the planning and implementation of Pharmacy operations for any lines of business in purview.
• Manage PBM contract for all lines of business while managing pricing and performance guarantees
• Initiate Request for Proposal (RFP) and market check for PBM
• Work closely with BCBSAZ sales team to provide support related to PBM programs and pricing
• Ensure initial and continuing competency of staff under their respective responsibility. Initiate recruitment, selection, and provides for training, development, coaching, and motivation of employees. Further, maintain and encourage a positive working environment through a variety of communication systems, positive recognition, intervention, and practice resignation recovery.
• Provide strategic direction, operational oversight, and financial impact analysis for all pharmacy programs and all programs.
• Ensure compliance with all CMS, Arizona Department of Insurance requirements for pharmacy services, pharmacy benefits, P & T committee, formulary development and maintenance, quality assurance and member safety, medication therapy management programs coordination with CCIP programs, pharmacy utilization management, exceptions, prior authorization, step therapies, grievance, and appeals.
• Serve as liaison with designated PBM to ensure compliance and operational efficiency related to pharmacy claims processing, claims reversals, Troop tracking and reporting, coordination of benefits, EOB determinations and reporting, low-income subsidy, Reinsurance calculations, Drug Claims data encountering, pharmacy access monitoring, home infusion pharmacy monitoring, long term care pharmacy monitoring, ITU pharmacy monitoring, Part D reporting. Leads joint operations with designated PBM to facilitate all Part D implementation issues, and ongoing operational issues.
• Develop and analyzes efficiency and quality metrics and improves performance on a continuous basis.
• Act as subject expert in all pharmacy operations areas and provides ongoing education to internal partners, members, and Network physicians.
• Perform all functions according to established policies, procedures, regulatory and accreditation requirements, as well as applicable professional standards. Provide all customers with an excellent service experience by consistently demonstrating core and leader behaviors each and every day.
• Responsible for the identification analytic opportunities, and the development and integration of analytics services to support operational efficiencies at point of sales, service, and care within the pharmacy care services areas.
• Managing annual market/check or RFP process for the pharmacy benefit manager review.  Including management of vendor hired for the process.
• Prepare and present executive reporting about our PBM including RFP/market check results.  Including making recommendations from results.
• Serves as the pharmacy leader liaison to underwriting and sales for our PBM pricing and relationship including assistance with benchmark preparations and reviews with client.
• Create and support quarterly medical drug pricing of HCPCs codes for professional fee schedule including monthly collaboration meeting with extend fee team.
• Support provider network team as requests from providers are made pertaining to the fee schedule.
• Work with modeling teams to create the proof of value models to gauge benefits and develop integration plans with application teams to leverage the models within the current application landscape.
• Identify opportunities and diagnose organizational opportunities to achieve administrative efficiencies while maintaining service and improving quality.
• Contribute to and lead departmental and cross-functional teams to achieve BCBSAZ goals and special projects identified by the CMO to ensure future success.
• Coordinate activities between multiple divisions to achieve desired results.
• Oversee departmental administration by coaching and motivating managerial staff and departmental personnel to make maximum use of experience and skills.
• Manage use of corporate funds including budgeting, financial management, and reporting. Identify opportunities to achieve administrative efficiencies while maintaining service.
• Coordinate operations and strategy for all areas of responsibility.  Plan, coordinate, and direct activities necessary to support the corporate goals and objectives.  Determine division organization. Participate in strategic planning activities and contribute to departmental and cross-functional teams to achieve BCBSAZ goals.
• Coordinate activities between multiple divisions to achieve desired results.
• Chair internal committees and serves on others as directed.
• Support BCBSAZ’s Core Value of maintaining a heritage of service, by volunteering with, serving on, and/or supporting multiple Boards of Directors within the community.
• The position requires a full-time work schedule. Full-time is defined as working at least 40 hours per week, plus any additional hours as requested or as needed to meet business requirements.
• Perform all other duties as assigned.

REQUIRED COMPETENCIES

Required Job Skills

• Strong written and verbal communications.
• Intermediate skill in use of office equipment including copier, fax machine, scanner, and telephones.
• Intermediate skill in word processing, spreadsheet, and database software.
• Intermediate PC proficiency.

Required Professional Competencies

• Analytical and critical thinking skills necessary to integrate and interpret data from diverse sources.
• Ability to integrate information to establish business-based priorities, decisions and budgets.
• Strong relationships with suppliers and customers and to effectively communicate with employees, medical staff, and management staff
• Communicate effectively at all levels and demonstrate leadership ability and group facilitation skills.
• Excellent management skills as they relate to clerical and professional staff
• Interpersonal skills that allow for harmonious relationships with providers, members and coworkers
• Create win/win situations through collaboration and negotiation
• Manage multiple priorities, high customer expectations and bridge the demands between internal and external customers
• Generate, select and implement solutions to improve process performance
• Knowledge of principles and methods related to implementing change management

Required Leadership Experience and Competencies

• High standard of performance while pursuing aggressive goals
• Make use of employees’ abilities and skills to deliver business objectives
• Use available information to focus the team’s activities and identify priorities
• Understanding of workflow systems to maximize resources and streamline processes for efficiencies

PREFERRED COMPETENCIES

Preferred Job Skills

• Understanding of informatics

Preferred Professional Competencies

• N/A    

Preferred Leadership Experience and Competencies

• N/A

Our Commitment

BCBSAZ does not discriminate in hiring or employment on the basis of race, ethnicity, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected veteran status or any other protected group.

Thank you for your interest in Blue Cross Blue Shield of Arizona.  For more information on our company, see azblue.com.  If interested in this position, please apply.