Director, Pharmacy and Clinical Consulting

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As the Director of Pharmacy and Clinical Consulting , you will participate in the strategy development and establishment of business goals to ensure alignment with our department's long term strategic objectives, core management program capabilities, and continued close partnership with functional areas across the company. The Director will oversee the development of pharmacy clinical quality and provider engagement programs, clinical consulting support for account management teams and customers, pharmacy product, and talent management to meet the evolving needs of the business.

This role provides people, program, and strategic leadership in close partnership with the VP, Pharmacy and Clinical Consulting and in close collaboration with their peer Director, Pharmacy and cross-functional departments to drive business outcomes.

What you will do:

• Set strategic direction for program development appropriate outcomes related to access, affordability, quality and experience.

• Lead the clinical consulting efforts with customers around their pharmacy and medical benefits, trends, and programs. Interface with sales/account management, brokers, clients/customers and Premera General Managers.

• Develop strategies for measuring and managing appropriate pharmacy utilization, negotiates and monitors contracted vendors, contributes to building physician relationships aimed at quality pharmaceutical care, and stays abreast of pharmacy benefits manager and payer industry environment.

• Collaborate on the development and implementation of comprehensive strategies for drugs across both pharmacy, medical benefits, including specialty, biosimilar, cell and gene therapies etc.

• Design and implement provider engagement program, generating insights, tactics to deliver managed and improve pharmacy trend and outcomes. Build strong external relationships with large multi-specialty provider groups.

• Develop and maintain effective relationships with actuarial, health care economics, sales, corporate communications, operations, product strategy and development, legal, underwriting, finance, customer service, congressional and legislative affairs, IT, and senior management to enhance collaboration for successful business outcomes.

• Oversite, direction for pharmacy clinical programs and associated compliance with regulatory (e.g. State, Federal) and quality accreditation standards (e.g. HEDIS, NCQA) for all lines of business (Commercial, Medicare Advantage, Individual, HMO, FEP).

• Develop and manage budget to anticipate and meet business needs.

• Oversee the Clinical Consulting team, including Pharmacists, Nurses, and support resources.

• Lead multidisciplinary teams in core areas of responsibility: Clinical Consulting team, comprised of pharmacists and nurses, Pharmacy Product , Pharmacy Clinical Quality and Medicare Advantage

• Attract, retain, and coach a high performing team, providing individuals growth opportunities to meet the evolving needs of the business.

• Participate in cross functional projects with multiple internal and external stakeholders and partner on execution.

What you will bring:

• Bachelor's degree in business or healthcare or four years' relevant experience.

• Ten years of experience in a large health plan, medical management or pharmacy management organization that includes care, case and pharmacy management, health and wellness and risk management. (Eight years of experience in this area if candidate holds a Pharmacy degree)

• Experience managing drug cost and utilization.

• Five years of experience managing a team.

Additional preferred skills/ experiences include:

• Pharmacy degree with graduate level education (e.g. PharmD, MHA, PhD or MBA).

• Current unrestricted registered pharmacist license in Washington State or ability to obtain within 6 months of hire.

• Experience partnering with sales and clients to win and grow health plan or pharmacy benefit membership

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What we offer

• Medical, vision and dental coverage

• Life and disability insurance

• Retirement programs (401K employer match and pension plan)

• Wellness incentives, onsite services, a discount program and more

• Tuition assistance for undergraduate and graduate degrees

• Generous Paid Time Off to reenergize

• Free parking

Equal employment opportunity/affirmative action:

Premera is an equal opportunity/affirmative action employer. Premera seeks to attract and retain the most qualified individuals without regard to race, color, religion, sex, national origin, age, disability, marital status, veteran status, gender or gender identity, sexual orientation, genetic information or any other protected characteristic under applicable law.

If you need an accommodation to apply online for positions at Premera, please contact Premera Human Resources via email at ~~~ or via phone at ~~~.

Premera is hiring in the following states, with some limitations based on role or city: Alaska, Arizona, Arkansas, California, Colorado, Florida, Georgia, Idaho, Iowa, Kansas, Kentucky, Maine, Michigan, Minnesota, Missouri, Montana, Nevada, New Hampshire, New Mexico, North Carolina, Oklahoma, Oregon, South Carolina, South Dakota, Tennessee, Texas, Utah, Washington, Wisconsin .

Salary Range:

$150,000.00 - $300,000.00

At Premera, we make healthcare work better. By focusing on improving our customers' experience purposefully and serving their needs passionately, we make the process easier, less costly, and more positive. Through empathy and advocacy, we change lives.

As the leading health plan in the Pacific Northwest, we provide comprehensive health benefits and services to more than 2 million customers, from individuals to Fortune 100 companies. Our services include innovative programs focused on health management, wellness, prevention, and patient safety. We deliver these programs through health, life, vision, dental, disability, and other related products and services.

Premera Blue Cross is headquartered in Mountlake Terrace, WA, with operations in Spokane and Anchorage. The company has operated in Washington since 1933 and in Alaska since 1952. With more than 80 years of experience in the region, we deliver innovation, choice, and expertise.