Director, Commercial Formulary and Medication Policy

** Job Description
** We’re seeking a Director, Commercial Formulary and Medication Policy to join our Commercial Pharmacy Team! In this critical role, you will 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.
** What You’ll Do
**** Leadership Responsibilities
*** People leadership
* Coverage strategy thought leadership
* Resource management
* Project planning and management
** Core Responsibilities
**** Strategy
* ** 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.
** Operations
* ** 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.
** Partnership and Vendor Management
*** Evaluate and manage new and/or existing vendors and solution partners to align to BCNC’s strategic direction
* Develop economic or quality models to evaluate new vendors
* Connect and maintain relationships with peer health plans to ideate on best practices from across the country in drug spend management.
** Program management and quality/compliance
*** Direct the development and oversight of commercial specialty pharmacy initiatives and pharmacy utilization management programs and policies to manage trend targets and reduce medical expense.
* Collaborate and consult with other pharmacy business segments as needed for efficient use of clinical resources
* Manage and oversee the development of and monthly maintenance of cost-effective formularies
* Identify new clinical initiatives and modifications to current programs and processes to improve the company’s competitive position.
* Ensure programs are compliant in accordance with regulations of State, Federal, and other accrediting bodies and ensure corrective action plans are implemented.
** Communications
* ** Represent the Pharmacy department at internal meetings by active participation in cross functional organizational committees ensuring corporate fitness and market position.
* Represent BCNC through delivery of presentations, speaking engagements and participation at PBM meetings/committees or external customer meetings as needed.
** Innovation
* ** Drive leadership in project planning, designing and implementing innovative solutions around medication management
* Evaluation of investment/partnership opportunities
** What You Bring
*** Degree in Pharmacy and 10 years of experience in pharmacy benefits management, managed care, and/or strategic…