E-Verify Program

Learn More About E-Verify and myE-Verify

Director, Commercial Formulary and Medication Policy

DirectorDirectorFull TimeRemoteTeam 501-1,000Since 1997H1B No SponsorCompany SiteLinkedIn

Location

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

Posted

8 days ago

Salary

$158.0K - $252.8K / year

Postgraduate Degree10 yrs expEnglish

Job Description

• 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

Related Categories

Related Job Pages

More Director Jobs

Director, Coding

Ensemble Health Partners

Innovation in Revenue Cycle Management

Director8 days ago
Full TimeRemoteTeam 5,001-10,000H1B No Sponsor

Director of Coding managing revenue cycle solutions at Ensemble Health Partners

United States
$92.4K - $138.6K / year

Clinical Coding Director, Payment Integrity

Humana

Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.

Director8 days ago
Full TimeRemoteTeam 10,001+Since 1961H1B Sponsor

Director of Payment Integrity leveraging data to improve claims accuracy at Humana

United States
$138.9K - $191K / year

Conservation Strategy & Programs Director

Cox Enterprises

For well over a century, Cox Enterprises has been shaping the future with daring ideas and values-driven thinking. Since our founding in 1898, our relentless spirit of innovation has driven us to disrupt industries and enhance the quality of life in the communities we serve. Through our major divisions — Cox Communications, Cox Automotive and Cox Farms — our people have countless opportunities to grow and make an impact in the communications and automotive industries, as well as in new ventures in agriculture, cleantech, digital media and more. As a privately-held, family-owned business, we know that people are our most valuable asset. We offer a supportive and inclusive environment with flexible career growth, amazing benefits and work-life balance at the forefront. Our mission, our ways of working and our commitment to people are what make our workplace culture remarkably flexible and resilient. Join us to build a better future and make your mark.

Director8 days ago
Full TimeRemoteTeam 10,001+Since 1898H1B Sponsor

Director leading conservation strategies for Cox’s environmental advocacy priorities

United States
$148.5K - $247.5K / year
Director8 days ago
Full TimeRemoteTeam 51-200Since 1977H1B No Sponsor

Director, Practice Analysis at CFA Institute guiding investment education frameworks

PythonSQL
Connecticut + 4 moreAll locations: Connecticut, New Jersey, New York, Maryland, Massachusetts
$130K - $170K / year