Job Description

Leads and manages the day-to-day operational and tactical aspects of all Medicare related PBM (Pharmacy Benefit Manager) activities, new initiatives, and other ongoing business deliverables in accordance with business needs. Identifies, evaluates, and resolves issues that conflict with PBM related deliverables. Collaborates closely with project team members, business owners and sponsors to develop and successfully implement projects/programs. Assesses ongoing performance risks, develops mitigation and contingency plans. Oversees program to ensure initiatives have required resources, meets milestones, and are successfully implemented. Leads and coordinates matrixed and/or cross-functional team.

What You'll Do

• Develops project plans and recommendations in support of Corporate Pharmacy objectives and leads implementation; tracks and reports on the status of efforts related to our PBM. Must ascertain, categorize, and manage projects in relation to corporate priorities.

• Negotiates resources to staff projects effectively with appropriate skill sets, aligning skills to the project's needs.

• Delegates work as required and ensures a quality end product through close customer contact and assesses customer/client satisfaction through direct feedback/evaluation.

• Coordinates development and implementation of policies and procedures as well as development of compliance measurements.

• Controls and monitors project effectiveness; updates project plans, as necessary.

• Ensures compliance with necessary audit requirements.

• Represents Blue Cross NC in meetings with external parties including consultants, vendors, and others and may include service delivery management of vendors.

• Assists with analysis and development of business processes to ensure quality, cost effectiveness, timeliness of customer service, and regulatory requirements and mandates are met.

• Develops escalation process to channel issues and concerns to appropriate parties.

• Evaluates program risks, developing contingency plans and responding to change in risk as initiatives progress.

• Develops effective business process improvement initiatives and communication plans.

• Performs analytic functions and coaches others in analytical production, technical and other areas.

• Proposes a variety of solutions to business issues/problems utilizing appropriate analysis tools (i.e., Cost/Benefit Analysis, Flowcharting, etc.).

• Documents and presents program management results through the development of criteria, issue analysis papers and reports; ensures that projects established objectives such as financial goals, where applicable and creates an evaluation plan to assess project performance in relation to stated goals.

• Develops and tracks budgets, operating plans, and financial cost forecasts to support the program's objectives.

• Provides indirect reports, if applicable, with well-defined expectations, ongoing feedback, coaching/ mentoring and/or training.

What You'll Bring (Hiring Requirements)

• Bachelor's degree or advanced degree.

• 8+ years of experience in related field.

• In lieu of degree, 10+ years of experience in related field.

• Direct experience leading and implementing pharmacy programs.

• The ideal candidate will have extensive experience with PBMs.

Salary Range

$91,100.00 - $164,000.00

About Us

It's an exciting time to work at Blue Cross and Blue Shield of North Carolina (Blue Cross NC). Health care is changing, and we're leading the way. We offer more than health insurance our customers can count on. We’re committed to better health and better health care − in our communities and beyond. Our employees bring energy and creativity to the workplace, and it shows in our innovative approach to improving the health and well-being of North Carolinians.

Blue Cross NC is a fully taxed, not-for-profit company headquartered in Durham, North Carolina. We serve more than 4.3 million members, and we employ more than 5,000 people across the country who are passionate about making health care better for all.

Help us lead the charge for better health care by joining our award-winning team. Discover tremendous opportunities with us to do challenging and rewarding work. Opportunities that can lead you to a fulfilling career, work that can help others lead healthier, happier lives.

Authorization to Work in the United States

We use E-verify to confirm authorization to work in the United States. To learn more about E-Verify, including your rights and responsibilities, please visit E-Verify Overview (https://www.e-verify.gov/employees/e-verify-overview) for English or Visión General de E-Verify (https://www.e-verify.gov/es/empleados/vision-general-de-e-verify) for Español.

For most roles, you can choose where to work - fully remote in one of the states listed below, in the office, or a hybrid of the two:

Alabama, Arizona, Arkansas, Colorado, Florida, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Michigan, Mississippi, Missouri, North Carolina, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Wisconsin, and Wyoming

Much more than a paycheck

The total value of working at Blue Cross NC goes far beyond your paycheck. We offer benefits and perks (https://careers.bluecrossnc.com/global/en/benefits) that help you thrive, such as competitive health benefits, bonus plans based on performance, 401(k) with employer match, paid time off (plus two well-being days), and a variety of career development and wellness programs.