Senior Manager, Pharmacy

Job Description

We're hiring a Senior Manager, Pharmacy, to oversee utilization management operations and clinical review teams in support of strategic and operational priorities for an assigned line of business (Commercial or Government) within the Pharmacy UM and Compliance vertical.

In this role, you will develop and execute plans to achieve all relevant operational and quality targets while maintaining strong relationships with stakeholders, internal and external partners, and vendors. You will promote proactive collaboration across teams to leverage operational efficiencies, identify best practices, and drive successful implementation.

The Senior Manager will represent team needs in departmental budget planning and divisional and enterprise roadmaps, including technology and digital initiatives, and partner across the organization to ensure successful execution. This individual will serve as a key liaison between frontline staff, leadership, and cross-functional partners, helping to align priorities and drive business outcomes.

What You’ll Do

Operations 

• Direct the management of operational aspects (clinical and non-clinical) of pharmacy UM services for assigned segment (Commercial or Government).
• Support managers with prioritization and routine program monitoring (start, stop, continue, enhance analysis) and actions; ensure alignment with departmental, segment, and enterprise goals.
• Monitor team dependencies, area performance and/or vendor/PBM services to proactively identify risks, remove barriers (both vendor and enterprise related) and escalate issues to Director for additional support as needed.
• Manages and/or supports implementation of corporate and departmental projects that impact UM operations of pharmacy services and its vendors 

Program management and quality/compliance 

• Manages the operations of overall utilization management programs and policies for assigned segment to manage trend targets, reduce medical expense and ensure cost effective operations. 
• Identifies new operational initiatives and modifications to current programs and processes to improve the company’s competitive position. 
• Ensures segment programs and operations are performing successfully and are compliant in accordance with regulations of State, Federal, and other accrediting bodies; ensures corrective action plans are implemented when applicable.

Strategy 

• Evaluates emerging pharmacy industry trends, best practices as well as overall industry and organizational challenges and strategic needs for the assigned segment to proactively recommend and drive UM interventions and programs to support segment goals and objectives.
• Participates in the development of departmental strategic plans and objectives to improve operational performance, revenue development and the member and provider experience. 
• Provides clinical consultation in the evolving medication therapy space; recommend UM strategies and innovative solutions related to traditional and specialty therapies. 
• Utilizes expertise to represent the Pharmacy department on cross functional organizational committees, C-suite presentations, external speaking engagements, PBM meetings/committees or external customer meetings as needed 

What You Bring

• Bachelor's degree or advanced degree in Pharmacy
• 8+ years of experience in a related field
• In lieu of degree 10+ years of experience in related field.
• A current pharmacy license is required. For some roles, NC licensure is needed.

Bonus Points(preferred qualifications)

• People leadership and career/professional development for staff experience
• Culture and engagement support and interventions experience
• Resource and budget management experience  
• Project planning and management experience

What You’ll Get 

• The opportunity to work at the cutting edge of health care delivery with a team that’s deeply invested in the community  
• 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   
• Learn more   

Salary Range

At Blue Cross NC, we take great pride in a fair and equitable com