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Director, Commercial Formulary and Medication Policy

DirectorDirectorOtherRemoteLeadTeam 501-1,000Since 1997H1B No SponsorCompany SiteLinkedIn

Location

Kentucky + 4 moreAll locations: Kentucky | Louisiana | North Carolina | Mississippi | South Carolina

Posted

132 days ago

Salary

$158.0K - $252.8K / year

Seniority

Lead

Postgraduate Degree10 yrs expEnglish

Job Description

Director, Commercial Formulary and Medication Policy

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• 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.

Job 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

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