Sr. Manager, Pharmacist (Formulary/PBM)

Your Role

The Formulary Strategy and Management team develops and maintains formularies that support competitive health plan products, manage health care costs, and meet regulatory requirements across Commercial Large Group, Commercial Small Group, Individual/Family, and Medicare lines of business. The Senior Manager, Pharmacist of Formulary Management reports to the Director, Formulary Strategy and Pharmacy & Therapeutics.

In this role, you will lead a team of pharmacists and operations specialists responsible for formulary operations, Centers for Medicare & Medicaid Services (CMS)/Medicare formulary and utilization management (UM) submissions, System for Electronic Rates and Forms Filing (SERFF) submissions, formulary and UM implementation and adjudication accuracy. You will partner with analytics, product, actuary, operations, vendors, and other business partners to develop and execute strategies that improve affordability, quality, compliance, and member experience.

Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow – personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.

Responsibilities

Your Work

In this role, you will:

• Lead day-to-day formulary operations and team performance to support compliant, accurate, and timely execution
• Develop formulary strategies using clinical evidence, treatment guidelines, claims analysis, competitive intelligence, drug pipeline information, and financial and market data
• Oversee accurate installation of drug formularies and UM rules to support compliant claims adjudication
• Ensure compliant CMS/Medicare formulary and UM submissions, SERFF submissions, formulary collateral, and change notices that support member and provider transparency
• Partner with cross-functional teams and vendors to coordinate implementation, monitor performance, and meet accreditation, regulatory, and compliance requirements
• Identify opportunities to improve quality, affordability, operational efficiency, and performance against benchmarks
• Support pharmacy resident and student precepting, as assigned

Qualifications

Your Knowledge and Experience

• Doctor of Pharmacy (PharmD) degree from an accredited school of pharmacy in the US.
• Active and unrestricted California Registered Pharmacist (RPh) license
• At least 8 years of managed care pharmacy experience
• 4 years of people management experience with direct responsibility for supervising, coaching, and evaluating direct reports
• Experience with Medicare, ACA, Exchange, CMS/Medicare formulary and UM submissions, SERFF submissions, and other applicable regulatory requirements
• Demonstrated ability to lead formulary and UM processes, projects, timelines, and cross-functional implementation activities
• Strong independent judgment, analytical thinking, problem-solving skills, and ability to use data to drive decisions and results
• Thorough knowledge of managed care and pharmacy benefit management practices, including UM
• Advanced proficiency with Microsoft Office applications, including Excel, Access, and PowerPoint

Hybrid

This role requires employees to be in-office based on our hybrid workplace model, balancing purposeful in-person collaboration with flexibility. For most teams, this means coming into the office two days each week.

Employees living more than 50 miles from an office location will work with their manager to determine in-office time based on business need.

About Blue Shield of California

As of January 2025, Blue Shield of California became a subsidiary of Ascendiun. Ascendiun is a nonprofit corporate entity that is the parent to a family of organizations including Blue Shield of California and its subsidiary, Blue Shield of California Promise Health Plan; Altais, a clinical services company; and Stellarus, a company designed to scale healthcare solutions. Together, these organizations are referred to as the Ascendiun Family of Companies.

At Blue Shield of California, our mission is to create a healthcare system worthy of our family and friends and sustainably affordable. We are transforming health care in a way that genuinely serves our nonprofit mission by lowering costs, improving quality, and enhancing the member and physician experience.

To achieve our mission, we foster an environment where all employees can thrive and contribute fully to address the needs of the various communities we serve. We are committed to creating and maintaining a supportive workplace that upholds our values and advances our goals.

Blue Shield is a U.S. News Best Company to work for, a Deloitte U.S. Best Managed Company and a Top 100 Inspiring Workplace. We were recognized by Fair360 as a Top Regional Company, and one of the 50 most community-minded companies in the United States by Points of Light. Here at Blue Shield, we strive to make a positive change across our industry and communities – join us!

Our Values:

• Honest. We hold ourselves to the highest ethical and integrity standards. We build trust by doing what we say we're going to do and by acknowledging and correcting where we fall short.
• Human. We strive to listen and communicate effectively, showing empathy by understanding others' perspectives.
• Courageous. We stand up for what we believe in and are committed to the hard work necessary to achieve our ambitious goals.

Our Workplace Model

We believe in fostering a workplace environment that balances purposeful in-person collaboration with flexibility - providing clear expectations while respecting the diverse needs of our workforce. Our workplace model is designed around intentional in-person interaction, collaboration, connection, creativity and flexibility:

• For most teams, this means coming into the office two days per week.

• Employees living more than 50 miles from an office location, out of state employees, and employees in certain member-facing roles should work with their manager to determine in-office time based on business need.

• For employees with medical conditions that may impact their ability to work in-office, we are committed to engaging in an interactive process and providing reasonable accommodations to ensure their work environment is conducive to their success and well-being.

The Company reserves the right to require more presence in the office based on business needs, and requirements are subject to change with periodic reviews.

Physical Requirements:

Office Environment - roles involving part to full time schedule in Office Environment. Based in our physical offices and work from home office/deskwork - Activity level: Sedentary, frequency most of work day.

Please click here for further physical requirement detail.

Equal Employment Opportunity:

External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.