Pharmacy Manager Commercial Markets
Blue Cross Blue Shield Kansas

Under the general direction of the Chief Pharmacist, the pharmacy manager - commercial markets will oversee pharmacy management of employer-sponsored health plans and exchange health plans. This role focuses on enhancing member outcomes through population health initiatives and clinical program development. The pharmacy manager will work closely with cross-functional teams and our pharmacy benefit manager (PBM) to ensure high-quality services, operational efficiency and program excellence.

"This position is eligible to work onsite or hybrid (9 or more days a month on site) in accordance with our Telecommuting Policy. Applicants must reside in Kansas or Missouri or be willing to relocate as a condition of employment."

Are you ready to make a difference? Choose to work for one of the most trusted companies in Kansas.

Why Join Us?

• Make a Positive Impact: Your work will directly contribute to the health and well-being of Kansans.
  
• Family Comes First: Total rewards package that promotes the idea of family first for all employees.
  
• Dynamic Work Environment: Collaborate with a team of passionate and driven individuals.
  
• Stability: 80 years of commitment, compassion and community
  
• Flexibility: options to work onsite or hybrid available
  
• Balance: paid vacation and sick leave with paid maternity and paternity available immediately upon hire
  
• Inclusive Work Environment: We pride ourselves on fostering a diverse and inclusive workplace where everyone is valued and respected.
  
  

Compensation

$130,800 - $155,000 annually
Exempt 19

• Blue Cross and Blue Shield of Kansas offers excellent competitive compensation with the goal of retaining and growing talented team members. The compensation range for this role is a good faith estimate, it is estimated based on what a successful candidate might be paid. All offers presented to candidates are carefully reviewed to ensure fair, equitable pay by offering competitive wages that align with the individual's skills, education, experience, and training. The range may vary above or below the stated amounts.
  

What you'll do

• Oversee the activities of the pharmacy benefit manager (PBM) in the administration of pharmacy benefit programs, such as benefit designs, network development, formulary decisions, and utilization management programs, as well as forming recommendations for program changes.
  
• Works with the pharmacy operations team to develop and implement pharmacy benefit solutions and ensure solutions are performing to expectations.
  
• Assist and support quality programs that promote measurement, monitoring and evaluation of services and work processes to improve the quality-based activities and outcomes, including but not limited to STARS or HEDIS measures.
  
• Develops timely, easily understood provider educational materials, newsletters for mass communication to providers, and may meet with providers as needed.
  
• Supports internal and external sales in their understanding of pharmacy programs and meets with external clients to discuss pharmaceutical utilization and trends.
  
• Participates in external committees/teams at the request of provider organizations or associations as required.
  
• Will be an active participant and representative of the Pharmacy Management Team and Medical Affairs Division on multiple cross-functional committees and work teams as assigned.
  
• Responsible for understanding and following URAC standards for essential job functions.
  
• Responsible for supporting oversight of all vendors administering the prescription drug benefit including but not limited to the pharmacy benefit management manager and specialty pharmacies.
  
• Responsible for leading and managing professional and/or non-professional staff.
  

What you need
Knowledge/Skills/Abilities

• Requires knowledge of formulary development, including pipeline analysis and trade impact.
  
• Requires knowledge of health plan/pharmacy benefit manager (PBM) interfacings and the ability to navigate between stakeholders from both entities
  
• Requires a working knowledge of pharmacy and professional provider business procedures and practice economics and the ability to apply this knowledge to acceptable reimbursement policy and network development.
  
• Requires detailed knowledge of pharmacy and professional claim adjudication systems, electronic claims processes and electronic prescribing. Requires a working knowledge of coding methodology, including CPT, HCPCS and ICD-9/ICD-10, and medical terminology.
  
• Requires knowledge of pharmaceutical care, drug utilization review, disease state management, and utilization management, including Department of Labor (DOL) standards and URAC accreditation.
  
• Requires detailed and expert knowledge of drug therapy, biologic and biopharmaceutical products, drug information systems and drug delivery systems. Requires knowledge of the pharmaceutical industry, biologic and biopharmaceutical product development and the FDA approval process.
  
• Requires knowledge in the evaluation of clinical drug trials, outcomes research and Pharmacoeconomics and the ability to apply this knowledge to the development of drug formularies and utilization management and drug utilization review programs.
  
• Requires an understanding of empathy with people as well as effective principles of communication, team participation and leadership and continuous quality improvement principles.
  

Education and Experience

• Bachelor of Science in Pharmacy or Pharmacy Doctorate required, MBA or MPH preferred
  
• Must have or be able to obtain a current, unrestricted license to practice pharmacy by the Kansas State Board of Pharmacy
  
• Minimum of five years of experience in pharmacy practice
  
• Minimum of two years of experience in a leadership role
  
• At least one year of experience in managed care pharmacy preferred.
  

Physical Requirements

• This position requires minimal lifting up to 20 pounds. Position is mainly stationary with use of the PC at least 75% of the workday.
  

Benefits & Perks

• Base pay is only one component of your competitive Total Rewards package
  
• Incentive pay program (EPIP)
  
• Health/Vision/Dental insurance
  
• 6 weeks paid parental leave for new mothers and fathers
  
• Fertility/Adoption assistance
  
• 2 weeks paid caregiver leave
  
• 5% 401(k) plan matching
  
• Tuition reimbursement
  
• Health & fitness benefits, discounts and resources
  

Our Commitment to Diversity, Equity, Inclusion, and Belonging

At Blue Cross and Blue Shield of Kansas, we are committed to fostering a culture of diversity, equity, inclusion, and belonging (DEIB), where mutual respect is at the foundation of our workplace. We provide equal employment opportunities to all individuals, regardless of race, color, religion, belief, sex, pregnancy (including childbirth, lactation, and related medical conditions), national origin, age, physical or mental disability, marital status, sexual orientation, gender identity, gender expression, genetic information (including characteristics and testing), military or veteran status, family or parental status, or any other characteristic protected by applicable law.

We believe that embracing diversity and authentically promoting inclusion, equity, and belonging among our team members is crucial to our collective success. By intentionally recruiting, developing, and retaining a diverse pool of talent, we cultivate an environment where everyone feels valued, heard, and empowered to contribute. Accommodations are available for applicants with disabilities upon request, ensuring an inclusive and accessible hiring process for all.

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