Resp & Qualifications

PURPOSE: 
The Pharmacy Strategy Director is responsible for leading the day-to-day operations, performance, and oversight of pharmacy economics and PBM functions. The Director will lead and oversee ongoing day-to-day functions of the PBM and pharmacy supply chain model to ensure long term performance, compliance, and operational excellence. This role is responsible for managing execution activities, aligning stakeholders, overseeing contract and vendor relationships, driving financial accountability, and ensuring business readiness. The ideal candidate will bring deep experience in PBM operations, pharmacy economics, and large-scale delivery.

ESSENTIAL FUNCTIONS:

    Supply Chain and Contracts & Vendor Management: 
o    Lead the operating model for pharmacy rebates and network discounts and PBM contract management. Collaborate to provide leadership and strategic direction, ensuring timely and successful delivery of business-related milestones. Oversee business execution team, ensuring alignment of team efforts goals and timelines. Make key business decisions in partnership with the business to keep deliverables on track.
o    Understand and implement pre-negotiated contract terms. Oversee PBM and supply chain contracts and Statements of Work (SOWs), ensuring alignment with strategic and operational needs. Analyze contract terms to identify value and communicate impacts to the business. Implement contracts with different groups and analyze economics of supply chain to translate into value story for CareFirst. Manage supply chain vendor relationships and negotiate future terms. Manage vendor performance and relationships to mitigate risk, track deliverables, and uphold contractual obligations. Negotiate performance guarantees and accountability metrics to ensure financial and operational value.

    Financial Oversight and Risk Management:
o    Lead financial forecasting, rebate tracking, and reconciliation across PBM relationships and vendor platforms. Partner with Finance and Actuarial to identify, assess, and mitigate financial discrepancies and risks tied to performance-based contracts. Oversee audit activities, claims validation, discount guarantees, and compliance with rebate terms. Conduct continuous risk assessments across all key accountability areas to proactively identify and manage risks. Determine appropriate mitigation plans for identified risks. Specific focus on creating and implementing risk mitigation plans. Proactively manage and escalate financial and operational risks to ensure continuity and compliance.
o    Lead the end-to-end financial reconciliation process with the PBM, including claims audits, rebate payments, discount guarantees, and performance-based contract settlements. Conduct financial modeling and forecasting as it relates to market events and changes in operating models. Monitor and analyze PBM performance against contractual financial terms, including administrative fees, price guarantees, and formulary incentives. Oversee rebate forecasting, collections, and tracking, ensuring timely payment and proper allocation to financial stakeholders. Partner with Finance to validate and reconcile PBM invoice data, including manufacturer rebates, network discounts, and clinical program credits. Identify financial discrepancies and lead resolution efforts with PBM partners to ensure contract compliance and financial accuracy. Translate PBM financial data into actionable insights for executive leadership, highlighting trends, risks, and opportunities. Drive accountability with PBM for delivering promised financial outcomes, escalating issues and managing corrective action plans as needed. Collaborate with actuarial, legal, and procurement teams to support ongoing financial modeling, renewals, audits, and contract negotiations.

    Cross-Functional Leadership and Business Readiness: 
o    Collaborate across PMO, IT, Operations, and other departments to ensure seamless system integration and business process alignment with the PBM model. Act as point of escalation for IT and PMO to facilitate and resolve issues and risks. Act as the strategic liaison between business sponsors and execution teams to ensure alignment, transparency, and readiness across all phases of delivery. Create alignment across PMO, IT, and Pharmacy on vision and strategy, driving progress and ensuring effective communication, training, and documentation.
o    Define, develop, and update the Pharmacy value story, quantifying performance improvements and investment impact. Communicate realized value to executive stakeholders, highlighting areas for optimization, cost savings, and service improvement. Serve as the primary point of contact for vendors and PBM. Develop internal and external comms in partnership with Marketing.

    People Leadership: 
o    Provide leadership and set a clear vision and direction to ensure the team meets organizational goals and objectives. Responsible for performance evaluation, pay reviews, hire/termination decisions, development plans, and setting goals within the context of the corporate policy. Provides coaching, counseling and motivation to team members improve performance, support career growth, establish succession planning, and ensure staff has the appropriate tools and training. Oversee team budget by planning, monitoring, and controlling expenditures. Develop forecasts, track spending, make necessary adjustments, and ensure transparency and accountability in all financial matters.

SUPERVISORY RESPONSIBILITY:
This position manages people.


QUALIFICATIONS:

Education Level: Bachelor's Degree in Business Administration, Healthcare Management, Supply Chain Management, or related field OR in lieu of a Bachelor's degree, an additional 4 years of relevant work experience is required in addition to the required work experience.

Experience: 8 years pharmacy supply chain, pharmacy business operations, PBM operations, PBM contracting, pharmacy services, or supply chain management and
3 years management experience.


Preferred Qualifications:

• MBA or other graduate degree in business related field.
• Previous experience leading a PBM health plan transition.

Knowledge, Skills and Abilities (KSAs)

• Strong knowledge of PBM contracting, claims adjudication, pharmacy network management, formulary design, financial processes including rebates and discounts, and compliance regulations.
• Strong decision-maker with the ability to navigate complex business issues and make strategic choices in collaboration with the business sponsor.
• Expertise in Medicare, Medicaid, and Commercial pharmacy operations.
• Experience managing PBM implementations or transitions at a health plan, PBM, or consulting firm.
• Adaptability and resilience in a dynamic, fast-paced environment.
• Excellent interpersonal skills with the ability to influence and engage senior stakeholders and vendors.
• Highly organized and detail-oriented, with the ability to manage large-scale, multi-functional projects with executive visibility.
• Excellent communication, negotiation, stakeholder engagement, and relationship management skills, both verbal and written.

Salary Range: $157,600 - $292,545

Salary Range Disclaimer

The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. This compensation range is specific and considers factors such as (but not limited to) the scope and responsibilites of the position, the candidate's work experience, education/training, internal peer equity, and market and business consideration. It is not typical for an individual to be hired at the top of the range, as compensation decisions depend on each case's facts and circumstances, including but not limited to experience, internal equity, and location. In addition to your compensation, CareFirst offers a comprehensive benefits package, various incentive programs/plans, and 401k contribution programs/plans (all benefits/incentives are subject to eligibility requirements).

Department

2024-2026 PBM/Pharmacy RFP Pro

Equal Employment Opportunity

CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer.  It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.

Where To Apply

Please visit our website to apply: www.carefirst.com/careers

Federal Disc/Physical Demand

Note:  The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.

PHYSICAL DEMANDS:

The associate is primarily seated while performing the duties of the position.  Occasional walking or standing is required.  The hands are regularly used to write, type, key and handle or feel small controls and objects.  The associate must frequently talk and hear.  Weights up to 25 pounds are occasionally lifted.

Sponsorship in US

Must be eligible to work in the U.S. without Sponsorship.

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