Sr. Manager, Pharmacist

1 day ago


Los Angeles CA United States Blue Shield of CA Full time

Your Role


The Formulary Strategy and Management team leads the development and maintenance of multiple formularies to support competitive health plan products, manage cost-of-healthcare, and meet regulatory requirements for all lines of business including Commercial Large Group, Commercial Small Group, Individual/Family plan, and Medicare. The Sr. Manager, Pharmacist (Senior Manager of Formulary Management) will report to the Director, Formulary Strategy and Pharmacy & Therapeutics. In this role, you will lead formulary management for the Medicare line of business. You will collaborate with Analytics, Product, Actuary, Benefits, Communications, Regulatory teams, and other business areas to identify and implement interventions to manage cost of healthcare through formulary and utilization management optimization. The Senior Manager is responsible for managing a team of pharmacists and pharmacy technicians responsible for the day-to-day Medicare formulary operations to ensure compliant CMS submissions as well as implementation and validation of all formularies on the claims adjudication system and the formulary management system. The Senior Manager is also responsible for managing the relationship with multiple formulary related vendors and as well as CMS related to formulary compliance and audits.


Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow - personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.


Your Knowledge and Experience


  1. Requires a Doctor of Pharmacy (PharmD) degree
  2. Requires at least 8 years of experience in a managed care setting, including at least 3 years of management experience or equivalent
  3. Requires a currently active and unrestricted California Registered Pharmacist (RPh) license
  4. Experience with Medicare, ACA, and Exchange regulatory requirements
  5. Requires practical knowledge in leading and managing the execution of formulary and utilization management related processes, projects and timelines. Ability to multi-task, prioritize, and deliver in a demanding and constantly changing corporate environment
  6. Proven record for driving to results through data-driven decision-making. Strong independent judgement, critical and analytics thinking, and problem-solving skills
  7. Thorough knowledge of managed care and pharmacy benefit management practices, including utilization management
  8. Advanced level skill and experience with MS Office applications including Access and Excel and PowerPoint

Pay Range:


The pay range for this role is: $145,970.00 to $218,900.00 for California.


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