Sr. Manager, Pharmacist (Short-Term Employment)

Company: Blue Shield of California
Location: Rancho Cordova
Posted on: November 18, 2023

Job Description:

JOB DESCRIPTIONYour RoleThe Formulary Strategy and Management team leads the development and maintenance of multiple formularies to support competitive health plan products, manage cost-of-healthcare, and meet regulatory requirements for all lines of business including Commercial Large Group, Commercial Small Group, Individual/Family plan, and Medicare. The Sr. Manager, Pharmacist of Formulary Management will report to the Director, Formulary Strategy and Pharmacy & Therapeutics. In this role, you will collaborate with Analytics, Product, Actuary, Benefits, and other business areas to identify and implement interventions to manage cost of healthcare through formulary and utilization management optimization. The Sr. Manager is responsible for managing a team of pharmacists and pharmacy technicians responsible for the day-to-day formulary operations to ensure compliant CMS and SERFF submissions, as well as, implementation and validation of all formularies on the claims adjudication system. 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 WorkIn this role, you will:Provide oversight for the management of program area operations and employeesBe responsible for promotion and execution of overall vision, goals, objectives of the business unitProvide oversight for the coordination of activities of the program area with other business units and monitor operational statistics to ensure all respective accreditation, regulatory and compliance requirements are metIdentify performance improvement opportunities to achieve or exceed benchmarks and advise on issues requiring immediate escalationProvide oversight for the development, implementation, coordination, and assessment of programs to improve quality and cost-effectivenessLeads development of formulary strategy for various market products, using clinical studies and guideline information, claims analyses, competitive intelligence, drug pipeline, financial and market dataManage formulary operations including accurate installation of drug formularies for compliant claims adjudication and collaborating with Drug Utilization Review and Prior Authorization teams for accurate implementation of drug coverage policies and criteria for compliant coverage determinationsOversees compliant formulary and UM submissions to regulators including creation and maintenance of all formulary collateral and formulary change notices for member/provider transparency, according to regulatory requirementsProvides oversight of vendor contracts and activities related to business functions and operationsPrecepts Pharmacy Practice Residents and students, as assignedQUALIFICATIONSYour Knowledge and ExperienceRequires a Doctor of Pharmacy (PharmD) degree and active, unrestricted California Registered Pharmacist (RPh) licenseRequires at least 8 years of experience in a managed care setting, including at least 3 years of management experience or equivalentExperience with Medicare, ACA, and Exchange regulatory requirementsRequires practical knowledge in leading and managing the execution of formulary and utilization management related processes, projects and timelines. Ability to multi-task, prioritize, and deliver in a demanding and constantly changing corporate environmentProven record for driving to results through data-driven, decision-making, problem-solving skillsThorough knowledge of managed care and pharmacy benefit management practices, including utilization managementAdvanced proficiency with MS Office applications including Access, Excel, and PowerPointPay Range:The pay range for this role is: $ 145200.00 to $ 217800.00 for California.Note:Please note that this range represents the pay range for this and many other positions at Blue Shield that fall into this pay grade. Blue Shield salaries are based on a variety of factors, including the candidate's experience, location (California, Bay area, or outside California), and current employee salaries for similar roles.ABOUT USAt 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!ABOUT THE TEAMBlue Shield of California's mission is to ensure all Californians have access to high-quality health care at a sustainably affordable price. 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 fulfill our mission, we must ensure a diverse, equitable, and inclusive environment where all employees can be their authentic selves and fully contribute to meet the needs of the multifaceted communities we serve. Our continued commitment to diversity, equity, and inclusion upholds our values and advances our goal of creating a healthcare system that is worthy of our family and friends while addressing health disparities, promoting social justice, and integrating health equity through our products, business practices, and presence as a corporate citizen.Blue Shield has received awards and recognition for being a certified Fortune 100 Best Companies to Work, Military Friendly Employer, People Companies that Care, a Leading Disability Employer, and one of California's top companies in volunteering and giving. 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 be our authentic selves, listening and communicating effectively, and showing empathy towards others by walking in their shoes.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:Blue Shield of California is dedicated to making work-life balance a reality. Whether you prefer to work in an office or from home, we understand flexibility is more important than ever. That's why Blue Shield is a hybrid company, offering you the opportunity to decide where you can do your best and most meaningful work.Two ways of working: Hybrid (our default) and officeHybrid - In a business unit approved office a few times per year to 3 days per week, on averageOffice - In a business unit approved office 4+ days a week, on average. If the role you're applying for is deemed an "Essential Role," the company has determined that the role can only be performed in a Blue Shield office or in the field and would require your to meet the office worker classification.Physical Requirements: Office Environment - roles involving part to full time schedule in Office Environment. Due to the current public health emergency in California, Blue Shield employees are almost all working remotely. 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.

Keywords: Blue Shield of California, Rancho Cordova , Sr. Manager, Pharmacist (Short-Term Employment), Healthcare , Rancho Cordova, California