Director, Specialty Pharmacy and Cost of Health Care

About the role

The Director, Pharmacist (Specialty Pharmacy and Cost of Health Care) will report to the Senior Vice President/Chief Pharmacy Officer. In this role, you will drive strategies and performance of pharmacy Cost of Health Care (COHC) programs to manage annual pharmacy benefit costs for over $5 billion. You will lead your team to work cross-functionally and partner with vendors to develop and implement end-to-end strategies and differentiating solutions in both pharmacy and medical benefits for Commercial and Medicare. You will also own and drive the Specialty drug management program, including management of cell and gene therapies.

Our leadership model focuses on developing great leaders at all levels and creating opportunities for personal, professional, and financial growth. We seek leaders energized by creative and critical thinking, building high-performing teams, achieving results ethically, and fostering continuous learning.

Responsibilities

• Oversee a team of pharmacists and program managers.
• Own the end-to-end Specialty Drug Management Program for specialty drugs covered under pharmacy and medical benefits to yield sustainable affordability.
• Partner with network teams to contract and reimburse differently (e.g., acquisition cost-based, ASP-based, provider fee schedule) with medical and pharmacy network providers.
• Partner with clinical and benefit product teams to optimize program strategies and effectiveness.
• Negotiate, oversee, and directly manage select specialty vendor contracts and outcomes.
• Support evaluation of manufacturer partnership programs and contracting opportunities (e.g., rebates, outcomes-based contracts).
• Lead development and implementation of the COHC initiative roadmap by lines of business (LOB) to meet trend and financial targets for Commercial and Medicare.
• Partner with pharmacy analytics and LOB teams to proactively evaluate pharmacy trend drivers, assess program ROI, and drive end-to-end COHC strategy and program design for pharmacy and medical benefit drug spend.
• Lead implementation of select initiatives to support Pharmacy Care Reimagined and biosimilars adoption.
• Evaluate emerging vendor solutions and partnership opportunities, and support contract development and negotiation.
• Build a high-performing team and foster a great workplace to do meaningful work.

Requirements

• Currently active and unrestricted California Registered Pharmacist (RPh) license.
• Doctor of Pharmacy (PharmD) degree from an accredited school of pharmacy in the U.S.
• At least 10 years of prior relevant experience, including evaluation of pharmacy program value and performance drivers.
• 6 years of management experience in health plans or pharmacy benefit management companies, with deep knowledge of pharmacy benefit, formulary and network products, program strategies, and competitive landscape.
• Excellent communication skills with prior experience presenting to internal and external executive-level business stakeholders.
• Strong business acumen with proven experience in pharmacy strategy development and planning.
• Excellent presentation, verbal, and written skills with the ability to convey complex ideas to audiences with diverse backgrounds.
• Detail-oriented with the ability to work in a fast-paced environment.
• Exhibit a "can-do" attitude and solution-oriented approach to resolving challenges.

Preferred qualifications: Prior experience in vendor partnership, contract operations, negotiations, and performance management.

Schedule

This role follows a hybrid workplace model, requiring in-office presence two days each week. Employees living more than 50 miles from an office location will work with their manager to determine in-office time based on business need.

Pay

Pay Range for California: $181,830.00 to $272,800.00

Pay Range for Bay Area: $204,972.00 to $307,520.00

Note: Salaries are based on factors including candidate experience, location (California, Bay Area, or outside California), and current employee salaries for similar roles.

About Us

Blue Shield of California is part of the Ascendium Family of Companies, which includes 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. Our mission is to create a healthcare system worthy of our family and friends—sustainably affordable, with lower costs, improved quality, and enhanced member and physician experiences.

We foster a supportive workplace that upholds our values—Honest, Human, and Courageous—and advances our goals. Blue Shield is recognized as a U.S. News Best Company to work for, a Deloitte U.S. Best Managed Company, and a Top 100 Inspiring Workplace. We were also recognized by Fair360 as a Top Regional Company and by Points of Light as one of the 50 most community-minded companies in the U.S.