Director of Commercial Formulary and Medication ...

Job Description Join our dynamic Commercial Pharmacy Team as the Director of Commercial Formulary and Medication Strategy! In this vital leadership role, you will spearhead initiatives that shape and advance our strategic and operational priorities within the Pharmacy group. You will manage a dedicated team focused on achieving pharmacy operations goals, clinical and specialty pharmacy programs, opportunity analysis, solution design, provider and payer integration, and vendor management. What You'll Do Leadership Responsibilities Foster a strong team culture through effective people leadership. Provide thought leadership on coverage strategies. Oversee resource management for operational effectiveness. Lead project planning and execution to meet organizational goals. Core Responsibilities Strategy Assess emerging pharmacy industry trends and align them with departmental business objectives. Manage all clinical aspects of drug coverage, including formulary management and policy development. Develop strategies that encompass total cost management and enhance patient outcomes. Work with analytics teams to create systems for tracking drug trends and utilization metrics. Contribute to strategic planning aimed at improving medical expense goals and clinical excellence. Stay informed on advancements in medication therapy and formulate corresponding strategies. Operations Oversee the development of formulary and medication policies focused on clinical quality and affordability. Manage daily operations regarding drug expenditure tracking in collaboration with medical economics teams. Lead corporate projects that require insights into drug utilization and pricing dynamics. Partnership and Vendor Management Evaluate and manage vendor partnerships to align with strategic business goals. Create economic and quality evaluation models for vendor assessments. Build and maintain relationships with peer health plans to share best practices in drug spend management. Program Management and Compliance Direct the oversight of specialty pharmacy initiatives and medication management policies. Collaboration with other pharmacy divisions to optimize resource use. Manage cost-effective formulary updates and programs. Identify and implement new clinical initiatives to enhance competitive positioning. Ensure compliance with regulations and implement corrective measures as needed. Communications Actively participate in organizational committees to represent the Pharmacy department. Deliver presentations and represent BCNC at various industry events and meetings. Innovation Lead innovative projects in medication management and evaluate partnership opportunities. What You Bring A degree in Pharmacy with 10 years of experience in pharmacy benefits management or managed care. Alternatively, a PharmD with 8 years of relevant experience. A minimum of 5 years in a leadership role managing teams or complex projects. Current pharmacy license may be required for some positions. Bonus Points (preferred qualifications) PharmD or licensed pharmacist with residency and/or Board certification. Experience with provider-administered specialty drug management. Collaboration with actuary and analytics teams in trend management. Experience in formulary management and leadership in Pharmacy and Therapeutics Committees. Expertise in both commercial and Medicare formulary and policy management. What You'll Get Opportunity to work at the forefront of healthcare delivery with a community-focused team. Flexible work-life balance and autonomy to excel in your role. Comprehensive health benefits including medical, dental, and vision coverage. Supportive parental leave, plus adoption and surrogacy assistance. Career development programs and tuition reimbursement for continued education. 401k match with an annual company contribution. #LI-Hybrid Salary Range At Blue Cross NC, we are committed to providing a competitive compensation package that reflects market standards. Our base salary is part of a comprehensive Total Rewards package that includes an Annual Incentive Bonus based on performance and corporate goals, alongside competitive health benefits. The salary range for this position is $157,978.00 - $252,765.00. Skills Required: Clinical Process Improvement Healthcare Management Managed Care Medicare Regulations Medication Management Pharmaceutical Industry knowledge Pharmacy Benefits Management (PBM) Pharmacy Compliance Pharmacy Operations Policy Development Quality Care Quality Management Regulatory Compliance Specialty Pharmacies Warning: Be cautious of job scams. Our hiring process does not involve payment or personal information requests via text. All legitimate job openings are listed on our official careers page.

Created: 2026-03-11