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Job Description

Leads and manages the day-to-day operational and tactical aspects of all Medicare related pharmacy benefit management (PBM) activities, new initiatives, and other ongoing business deliverables in accordance with business needs. Identifies, evaluates, and resolves issues with PBM related deliverables. Resolves issues by utilizing facts, knowledge, and experience to steer towards favorable business outcomes. Serves as a trusted solutions advisor by developing strong stakeholder relationships. Collaborates closely with project team members, business owners and sponsors to develop and successfully implement projects/programs. Assesses ongoing performance risks and communicate trends to develop next best action. Oversees program to ensure initiatives have required resources, meets milestones, and are successfully implemented. Leads and coordinates matrixed and/or cross-functional team. Articulates complex concepts that can cause a roadblock and puts forward proposal to advance projects / programs.

What You'll Do

• Develops project plans and recommendations in support of Corporate Pharmacy objectives and leads implementation; tracks and reports on the status of efforts related to our PBM. Must ascertain, categorize, and manage projects in relation to corporate priorities.

• Negotiates resources to staff projects effectively with appropriate skill sets, aligning skills to the project's needs.

• Delegates work as required and ensures a quality end product through close customer contact and assesses customer/client satisfaction through direct feedback/evaluation.

• Coordinates development and implementation of policies and procedures as well as development of compliance measurements.

• Controls and monitors project effectiveness; updates project plans, as necessary.

• Ensures compliance with necessary audit requirements.

• Represents Blue Cross NC in meetings with external parties including consultants, vendors, and others and may include service delivery management of vendors.

• Assists with analysis and development of business processes to ensure quality, cost effectiveness, timeliness of customer service, and regulatory requirements and mandates are met.

• Develops escalation process to channel issues and concerns to appropriate parties. Pre-empts and avoid conflicts using escalation paths effectively.

• Evaluates program risks, developing contingency plans and responding to change in risk as initiatives progress.

• Develops effective business process improvement initiatives and communication plans.

• Performs analytic functions and coaches others in analytical production, technical and other areas.

• Proposes a variety of solutions to business issues/problems utilizing appropriate analysis tools (i.e., Cost/Benefit Analysis, Flowcharting, etc.).

• Documents and presents program management results through the development of criteria, issue analysis papers and reports; ensures that projects established objectives such as financial goals, where applicable and creates an evaluation plan to assess project performance in relation to stated goals.

• Develops and tracks budgets, operating plans, and financial cost forecasts to support the program's objectives.

• Provides indirect reports, if applicable, with well-defined expectations, ongoing feedback, coaching/ mentoring and/or training.

What You'll Bring (Hiring Requirements)

• Bachelor's degree or advanced degree.

• 5+ years of experience in related field.

• In lieu of degree, 7+ years of experience in related field.

• Direct experience leading and implementing pharmacy programs.

• The ideal candidate will have extensive experience with PBMs.

Salary Range

At Blue Cross NC, we take great pride in a fair and equitable compensation package that reflects market-price and our starting salaries are typically planned near the middle of the range listed. Compensation decisions are driven by factors including experience and training, specialized skill sets, licensure and certifications and other business and organizational needs. Our base salary is part of a robust Total Rewards package that includes an Annual Incentive Bonus*, 401(k) with employer match, Paid Time Off (PTO), and competitive health benefits and wellness programs.

*Based on annual corporate goal achievement and individual performance.

$91,100.00 - $164,000.00

About Us

It's an exciting time to work at Blue Cross and Blue Shield of North Carolina (Blue Cross NC). Health care is changing, and we're leading the way. We offer more than health insurance our customers can count on. We’re committed to better health and better health care − in our communities and beyond. Our employees bring energy and creativity to the workplace, and it shows in our innovative approach to improving the health and well-being of North Carolinians.

Blue Cross NC is a fully taxed, not-for-profit company headquartered in Durham, North Carolina. We serve more than 4.3 million members, and we employ more than 5,000 people across the country who are passionate about making health care better for all.

Help us lead the charge for better health care by joining our award-winning team. Discover tremendous opportunities with us to do challenging and rewarding work. Opportunities that can lead you to a fulfilling career, work that can help others lead healthier, happier lives.

Authorization to Work in the United States

We use E-verify to confirm authorization to work in the United States. To learn more about E-Verify, including your rights and responsibilities, please visit E-Verify Overview (https://www.e-verify.gov/employees/e-verify-overview) for English or Visión General de E-Verify (https://www.e-verify.gov/es/empleados/vision-general-de-e-verify) for Español.

For most roles, you can choose where to work - fully remote in one of the states listed below, in the office, or a hybrid of the two:

Alabama, Arizona, Arkansas, Colorado, Florida, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Michigan, Mississippi, Missouri, North Carolina, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Wisconsin, and Wyoming