Director, Pharmacy Operations

About the role

The Pharmacy Operations team provides management and end-to-end oversight of Pharmacy operations, incident management, and driving resolution from identification to resolution within a matrixed environment. The Director, Pharmacy Operations will report to the Senior Vice President / Chief Pharmacy Officer.

Responsibilities

• Lead a team to track and drive accurate, timely and exceptional pharmacy benefit operations for all lines of businesses.
  • The scope includes but not limited to pharmacy benefit claims processing, integrated accumulators, pharmacy networks, annual pharmacy benefit implementation and business requirements development and maintenance.
• Monitor ongoing performance and drive solutioning and timely resolution of issues that may involve multiple vendors, including information technology (IT), claims processing, retail, home delivery, and specialty pharmacies.
• Provide accurate and timely pharmacy benefit research and consultative services to support escalated pharmacy-related questions from members and employer group clients.
• Develop end-to-end performance metrics and measurements to monitor, report, and explain pharmacy operations performance to internal stakeholders.
• Lead, drive and/or negotiate with vendors and teams where necessary to facilitate development of timely and thorough work plan to resolve operational issues, support benefit implementation, and adherence to contract requirements and expectations.
• Mentor a team of managers, supervisors, and individual contributors and build a high performing workplace to do meaningful work.

Qualifications

• Requires a college degree or equivalent experience.
• Requires 10 years of health plan and/or pharmacy benefit manager (PBM) operations experience.
• Requires 6 years of experience managing teams in pharmacy claims processing, pharmacy benefit implementation, and vendor management.
• Requires excellent written and verbal communication skills. Experience and skills in presenting complex operational subjects to executive and non-technical audiences is preferred.
• Experience and skills in leading and driving cross functional team consensus and discussions, including internal business partners and external vendors is preferred.

About Us

About Blue Shield of California As of January 2025, Blue Shield of California became a subsidiary of Ascendiun. Ascendiun is a nonprofit corporate entity that is the parent to a family of organizations including Blue Shield of California and its subsidiary, Blue Shield of California Promise Health Plan; Altais, a clinical services company; and Stellarus, a company designed to scale healthcare solutions. Together, these organizations are referred to as the Ascendiun Family of Companies. At Blue Shield of California, our mission is to create a healthcare system worthy of our family and friends and sustainably affordable. 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 achieve our mission, we foster an environment where all employees can thrive and contribute fully to address the needs of the various communities we serve. We are committed to creating and maintaining a supportive workplace that upholds our values and advances our goals. Blue Shield is a U.S. News Best Company to work for, a Deloitte U.S. Best Managed Company and a Top 100 Inspiring Workplace. We were recognized by Fair360 as a Top Regional Company, and one of the 50 most community-minded companies in the United States by Points of Light. 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 listen and communicate effectively, showing empathy by understanding others' perspectives.
• Courageous. We stand up for what we believe in and are committed to the hard work necessary to achieve our ambitious goals.

Physical Requirements

Office Environment - roles involving part to full time schedule in Office Environment. Based in our physical offices and work from home office/deskwork - Activity level: Sedentary, frequency most of work day. Please click here for further physical requirement detail.

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.