Director, Commercial Formulary and Clinical Programs - Capital Blue Cross

Position Description

Base pay is influenced by several factors including a candidate’s qualifications, relevant experience, and anticipated contributions to meet the needs of the business, along with internal pay equity and external market driven rates. The salary range displayed has not been adjusted for geographical location. This range has been created in good faith based on information known to Capital Blue Cross at the time of posting and may be modified in the future. Capital Blue Cross offers a comprehensive benefits packaging including Medical, Dental & Vision coverage, a Retirement Plan, generous time off including Paid Time Off, Holidays, and Volunteer time off, an Incentive Plan, Tuition Reimbursement, and more. 

At Capital Blue Cross, we promise to go the extra mile for our team and our community. This promise is at the heart of our culture, and it’s why our employees consistently vote us one of the “Best Places to Work in PA.”

The Director of Commercial Formulary and Clinical Programs is responsible for the routine oversight and maintenance of company-wide commercial formulary strategy and commercial pharmacy clinical program strategy and support. This leader will initiate and monitor both prospective and retrospective views of targeted drug utilization to perform continuous quality and utilization improvement. Oversight of the future drug pipeline and planning, oversight of the formulary management process, as well as oversight of the commercial clinical pharmacy team will all be key responsibilities of this position. Collaboration to develop new and innovative clinical pharmacy programs will be required. This role will work cross-functionally within Capital in alignment with Medicare/Government Pharmacy benefit, medical, trade and pricing, and overall corporate strategy.

Responsibilities and Qualifications

• Lead the Pharmacy & Therapeutics and formulary management process.
• Develop or lead evidence-based formulary decision making for CBC.
• Coordinate the design and management of Medication Use Evaluations for Capital populations.
• Develop or lead the development of value-based drug lists and specialty drug lists to ensure effective maintenance and claims adjudication.
• Monitor the pipeline and work collaboratively to establish clinical management pathways.
• Work with actuarial services to make impact projections of specific drug classes.
• Oversee the Commercial benefits team
• Ensure alignment of formulary decision making with pharmaceutical manufacturer contracting opportunities.
• Work in collaboration with the Medical Policy team to manage pharmacy formulary across benefits.
• Monitor drug utilization and expense trends closely to initiate management strategies

Job Requirements

 

Leadership:

• Ability to effectively lead and manage professional and non-professional staff.
• Ability to interact effectively with internal and external leaders.
• Ability to think strategically and plan effectively.

Knowledge:

• Extensive clinical knowledge of medical and pharmacy practice management strategies required.
• Extensive practical application experience of formulary strategies required.
• Extensive knowledge of completing evidence-based formulary reviews, supportive literature evaluation, development of clinical pharmacy programs, presenting clinical information to providers and committees required.
• Working knowledge of NCQA / HEDIS requirements preferred.
• Specialty pharmacy management experience preferred.

Skills:

• Effective communication skills both written and verbal.
• Effective presentation skills.
• Effective people and operations management skills.
• Effective time and priority management skills.
• Effective data analytical skills.

Experience:

• 5 Years of prior experience in formulary management preferred.
• 5 Years of prior experience in a managed care setting or PBM preferred.
• 5 Years of practical pharmacy experience preferred.
• Prior experience leading professional and non-professional staff preferred.

Education, Certification, and Licenses:

• Bachelors or Pharmacy Degree from an accredited college of pharmacy required. (PharmD Preferred)
• Active and unrestricted pharmacy license in the State of Pennsylvania required.
• Pharmacy Practice residency preferred.
• Masters in Business Administration preferred.

Location:

• This position is classified hybrid, which requires onsite work on Tuesdays and Wednesdays.

Travel Requirements:

• Up to 15%

Physical Demands:

• While performing the duties of the job, the employee is frequently required to sit, use hands and fingers, talk, hear, and see.
• The employee must occasionally lift and/or move up to 5 pounds.

 

About Us

We recognize that work is a part of life, not separate from it, and foster a flexible environment where your health and wellbeing are prioritized. At Capital you will work alongside a diverse and caring team of supportive colleagues, and be encouraged to volunteer in your community.  We value your professional and personal growth by investing heavily in training and continuing education, so you have the tools to do your best as you develop your career.     And by doing your best, you’ll help us live our mission of improving the health and well-being of our members and the communities in which they live.