Pharmacist, Principal

Your Role

The Pharmacy Markets, Products, Analytics and Strategies (RxMAPS) team is responsible for leading and collaborating cross-functionally with key stakeholders across Pharmacy Strategy and Operations and Blue Shield.  The RxMAPS team drives analytic strategy and performs clinical and business analyses necessary to provide consultations and strategic program recommendations to improve Cost of Health Care (COHC) and optimize outcomes. The Principal Pharmacist, Cost of Health Care will report to the Senior Manager, Rx Data Information Oversight and Reporting. In this role you will play a key role in leading and collaborating cross-functionally with key stakeholders across Blue Shield to drive analytic strategies and perform clinical and business analyses to improve COHC and optimize outcomes.  You will monitor pharmacy and medical drug trends and the drug pipeline, and work with Actuarial and Finance teams to explain drivers of trend and identify opportunities for trend management.  You will work with Enterprise Analytics to track and forecast COHC savings from pharmacy initiatives.
 

Your Work

In this role, you will:

• Analyze and monitor prescription drug claims, medical drug claims, and program data to identify opportunities to improve quality and cost of healthcare
• Serve as a BSC Pharmacy Strategy and Operations contact and subject matter expert to stakeholders, and manage external relationships (vendors, clients) related to assigned work
• Proactively monitor pharmacy trends (e.g., brand and generic drug pipeline, new legislation and regulatory requirements, COHC initiatives)
• Provide pharmacy trend driver variance explanation (e.g., utilization, drug mix, unit cost)
• Present findings on drug pipeline, COHC initiative savings, and other drivers of trend to help drive COHC initiative ideation and strategy with cross-functional stakeholders
• Support Enterprise Analytics in developing COHC savings methodology and reporting to estimate, track, and forecast COHC initiative savings
• Work with Actuarial teams to enable accurate pharmacy pricing and trend forecast for quarterly Trendsetter processes
• Participate in lines of business finance and performance review meetings to understand and/or provide input on business drivers and objectives
• Work cross-functionally to support and drive on-time submission of select state and federally mandated reports
• Respond to trend surveys, request for proposals, and other data analytic requests

Your Knowledge and Experience

• Requires a Doctor of Pharmacy (PharmD) degree
• Requires a currently active and unrestricted California Registered Pharmacist (RPh) license
• Requires at least 4 years of experience in clinical pharmacy
• Requires at least 3 years of experience in pharmacy benefit management and managed care health plan working with large pharmacy and medical claims datasets
• Experience with other pharmacy data (e.g., pharmacy and medical rebates, pharmacy networks, prior authorization) is preferred
• Requires proficient data analytic skills with Microsoft Office (e.g., Excel and Access) and other data analytic tools (e.g., SQL, SAS, Snowflake, Tableau)
• Requires ability to leverage business and clinical knowledge to interpret health plan benefit utilization and pharmacy financial data and derive actionable recommendations for COHC savings initiatives
• Requires understanding of pharmacy data parameters available for analysis
• Requires ability to work independently with minimal oversight and direction from the manager
• Requires ability to work collaboratively with multi-disciplinary and cross functional teams
• Requires excellent presentation, verbal, and written skills with ability to understand and convey complex ideas to an audience with diverse backgrounds
• Requires the ability to work in a fast-paced environment with a "can do" attitude and solution-oriented approach to resolve challenges