Director, Commercial Formulary and Medication Policy
E-Verify Program
full-time
Posted on:
Location Type: Remote
Location: Kentucky • Louisiana • United States
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Salary
💰 $157,978 - $252,765 per year
Job Level
About the role
- Direct, manage and lead efforts that define and enable strategic and operational priorities for the Pharmacy group.
- Lead staff responsible for accomplishing goals related to pharmacy operations, clinical and specialty pharmacy programs, opportunity analysis, solution design, provider/payer integration and vendor evaluation and management.
- Provides expertise and insights in drug coverage for provider administered therapy, pharmacy channel specialty drugs, and traditional retail medications.
- Champion innovation while identifying pharmacy-related opportunities and collaborations that drive value for Blue Cross NC members.
- Evaluate emerging pharmacy industry trends and the strategic needs of the department as it relates to overall business objectives.
- Oversee all clinical aspects of drug coverage from formulary management, policy development, and drug channel management.
- Develop new strategies to include total cost management, including real-world evidence for lowering total cost of care beyond drug expenditure to patient outcomes.
- Develop, in partnership with analytics teams, infrastructure to track drug trends and dissect changes in unit cost, utilization, and drug mix to support new ideation in management.
- Participate in the development of departmental strategic plans and objectives to improve achieve medical expense goals while maintaining standards in clinical excellence.
- Understand the evolving medication therapy space and develop strategies around traditional, specialty and gene therapies.
- Direct the management of formulary and medication policy development and maintenance for the purpose clinical quality and affordability.
- Oversee day-to-day operations related to tracking and managing drug expenditure in collaboration with medical economics teams in order to manage emerging trends in cost and clinical quality.
- Direct, manage, and/or support implementation of corporate projects that requires input on drug utilization, unit costs, and pricing dynamics in the pharmaceutical supply chain.
Requirements
- Degree in Pharmacy and 10 years of experience in pharmacy benefits management, managed care, and/or strategic or product development.
- Or: PharmD with 8 years of experience as stated above.
- 5 years of leadership experience, leading people and/or complex, cross divisional projects or programs.
- For some positions, a current pharmacy license is required.
- Bonus Points (preferred qualifications) PharmD degree or licensed pharmacist with residency and/or board certification in lieu of PharmD.
- Experience in provider administered (medical benefit) specialty drug management
- Experienced collaboration with actuary and analytics teams in the trend management space.
- Custom formulary and drug policy management experience with leadership history in Pharmacy and Therapeutics Committees
- Experience in both commercial and Medicare formulary and policy management.
Benefits
- Work-life balance, flexibility, and the autonomy to do great work
- Medical, dental, and vision coverage along with numerous health and wellness programs
- Parental leave and support plus adoption and surrogacy assistance
- Career development programs and tuition reimbursement for continued education
- 401k match including an annual company contribution
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
pharmacy benefits managementmanaged carestrategic developmentproduct developmentdrug coverage expertiseformulary managementpolicy developmentdrug channel managementcost managementdrug utilization management
Soft Skills
leadershipcollaborationstrategic planninginnovationanalytical thinkingcommunicationproject managementteam managementproblem-solvingcross-divisional leadership
Certifications
PharmDpharmacy licenseboard certification