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Job Posting Title

Job Description

The Clinical Program Management Director is responsible for the overall coordination and leadership of clinical pharmacy programs for their Blue Cross and Blue Shield (BCBS) clients and serves as the primary clinical relationship manager. This role’s responsibilities may include the management of drug formulary, Utilization Management (UM) programs, benefit design strategies, and other drug therapy related products and services offered by Prime. As the primary point of contact for their designated BCBS clients, the director promotes and recommends Prime standard offerings to meet client requirements and builds strong relationships with key clinical stakeholders through effective consultative services.

Responsibilities

• Coordinate and lead the development, maintenance, and implementation of client specific clinical pharmacy programs in tandem with key internal business partners; programs may include clinical portions of internal and external client planning documents and/or UM program implementations and formulary management (planning P&T agenda and client recommendations, maintenance of formulary information in provider and member materials/communications, distribution of formulary publications/communications)

• Establish a relationship with the client’s clinical stakeholders through representation of Prime on the client’s internal committees addressing drug therapy, medical, and clinical pharmacy benefit management related issues

• Coordinate efforts with Prime’s Pharmaceutical Trade Relations team when developing programs and relationships with pharmaceutical companies

• May provide work direction to a Clinical Program Manager or Clinical Program Specialist

• Provide consultation and recommendations to the client regarding Prime standard clinical program opportunities, formulary recommendations, benefit design recommendations, and other research applications and opportunities beneficial or of interest to the plan

• Provide clinical guidance and support for client’s Health Insurance Marketplace business

• Manage incoming requests for information from the plan regarding drug therapy, formulary and clinical program related issues and partner with reporting and analytics team to present meaningful information back to the client

• Present Prime’s products, services and recommendations to internal and external stakeholders and work in cooperation with Prime’s operational teams to coordinate and lead client specific custom clinical pharmacy programs

• Other duties as assigned

Minimum Qualifications

• PharmD or Bachelor of Science Pharmacy degree

• Current pharmacist license in good standing with State Board of Pharmacy in the State where the position is located

• 7 years of related work, educational, and/or resident experience to include at least 5 years of experience in managed care or clinical pharmacy

• Must be eligible to work in the United States without need for work visa or residency sponsorship

Additional Qualifications

• Ability to establish rapport and build relationships at all levels within an organization

• Expert negotiation and influencing skills

• Exceptional written and verbal communication skills

• Works effectively across functions, disciplines and/or other groups

• Ability to anticipate needs and plan work independently

• Demonstrated ability to problem solve through complex situations

Preferred Qualifications

• PBM Experience

• 1 year of management/people leadership experience

Minimum Physical Job Requirements

• Ability to travel up to 20% of the time

• Constantly required to sit, use hands to handle or feel, talk and hear

• Frequently required to reach with hands and arms

• Occasionally required to stand, walk and stoop, kneel, and crouch

• Occasionally required to lift and/or move up to 10 pounds and occasionally lift and/or move up to 25 pounds

• Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus

Reporting Structure

• Reports to Sr Director or VP in the Clinical Program Management department