Resp & Qualifications
PURPOSE:
The Pharmacy Supply Chain Director is responsible for leading critical financial and analytic functions within the Pharmacy Management department. This role ensures the organization maximizes contractual value by overseeing reconciliation of pharmacy rebates and network discounts with the PBM and medical rebates with Synergies, delivers timely and accurate rebate and discount calculations to self-insured ASO/CFA accounts, and builds, maintains, and enhances enterprise pharmacy data and analytics capabilities
ESSENTIAL FUNCTIONS:
Pharmacy Supply Chain (Pharmacy & Medical Rebate Reconciliation): Lead the end-to-end reconciliation of all pharmacy rebates, network discounts, and medical rebates to ensure contractual financial guarantees are met. Interpret multiple complex contract terms, conditions, definitions, and financial guarantees, translating them into claim-level mapping and reconciliation processes. Validate that each eligible claim receives the correct rebates and discounts, applying exclusions accurately based on contract terms. Monitor PBM compliance with timeliness and accuracy of payments. Identify and resolve discrepancies and proactively dispute as needed. Develop and maintain comprehensive reconciliation reporting for internal stakeholders and audit purposes. Maintain audit-ready processes and documentation with strong internal controls. Identify and report trends in financial performance to support strategic decision-making.
ASO Supply Chain Calculation & Allocation: Manage timely and accurate calculation and allocation of pharmacy rebates, network discounts, and medical rebates for self-insured ASO/CFA accounts. Interpret financial terms, conditions, definitions, and exclusions from ASO contracts and configure rules to ensure precise rebate and discount computations. Ensure contractual guarantees are met with transparency, fairness, timeliness, and accuracy. Collaborate with internal stakeholders, including Finance and Accounting to deliver reports and address client inquiries. Support financial audits by maintaining audit-ready methodologies, documentation, and allocation processes. Ensure medical rebate allocations are correctly integrated into ASO/CFA reporting. Continuously monitor and optimize calculation processes for efficiency and accuracy.
Pharmacy Data & Analytics: Lead the pharmacy data management and analytics strategy to deliver accurate, reliable, and actionable insights. Build, maintain, and enhance the Pharmacy Performance Monitoring tool to provide operational and financial insights. Ensure robust data governance for integrity and readiness in decision-making. Drive proactive pharmacy insights through optimized dashboards, reporting, and analytics. Develop processes and documentation to embed data-driven decision-making and foster continuous improvement. Advance the future-state pharmacy analytics operating model to prepare for Synergies integration and enterprise-level insights. Maintain audit-ready analytics and governance processes aligned with internal standards.
People Leadership: Provide strategic oversight across Pharmacy Supply Chain, Data, and Analytics functions. Lead, mentor, and develop high-performing staff across all areas. Partner with internal stakeholdersincluding Finance, Legal, Compliance, Actuarial, and Clinical teamsto ensure alignment and delivery of enterprise priorities. Communicate complex financial and analytic insights clearly to executive stakeholders. Foster a culture of accountability, accuracy, and continuous improvement.
SUPERVISORY RESPONSIBILITY:
This position manages people.
QUALIFICATIONS:
Education Level: Bachelor's Degree in Business Administration, Finance, Supply Chain Management, or related field OR in lieu of a Bachelor's degree, an additional 4 years of relevant work experience is required in addition to the required work experience.
Experience:
8 years progressive experience in pharmacy within one or more of the following areas: PBM, healthcare finance, supply chain, or analytics.
3 years management experience.
Preferred Qualifications:
MBA or other graduate degree in business related field
Knowledge, Skills and Abilities (KSAs)
Strong knowledge of PBM contracting, claims adjudication, pharmacy network management, formulary design, financial processes including rebates and discounts, and compliance regulations.
Strong decision-maker with the ability to navigate complex business issues and make strategic choices in collaboration with the business sponsor.
Expertise in Medicare, Medicaid, and Commercial pharmacy operations.
Experience managing PBM implementations or transitions at a health plan, PBM, or consulting firm.
Adaptability and resilience in a dynamic, fast-paced environment.
Excellent interpersonal skills with the ability to influence and engage senior stakeholders and vendors.
Highly organized and detail-oriented, with the ability to manage large-scale, multi-functional projects with executive visibility.
Excellent communication, negotiation, stakeholder engagement, and relationship management skills, both verbal and written.
Proven ability to manage timely and accurate reconciliation and allocation of rebates and network discounts within pharmacy supply chain.
Experience in building and maintaining pharmacy data governance and analytic tools.
Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence. Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.
Salary Range: $157,600 - $292,545
Salary Range Disclaimer
The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. This compensation range is specific and considers factors such as (but not limited to) the scope and responsibilities of the position, the candidate's work experience, education/training, internal peer equity, and market and business consideration. It is not typical for an individual to be hired at the top of the range, as compensation decisions depend on each case's facts and circumstances, including but not limited to experience, internal equity, and location. In addition to your compensation, CareFirst offers a comprehensive benefits package, various incentive programs/plans, and 401k contribution programs/plans (all benefits/incentives are subject to eligibility requirements).
Department
PBM/Pharmacy RFP
Equal Employment Opportunity
CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.
Where To Apply
Please visit our website to apply: www.carefirst.com/careers
Federal Disc/Physical Demand
Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.
PHYSICAL DEMANDS:
The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, @type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted.
Sponsorship in US
Must be eligible to work in the U.S. without Sponsorship
LI-LJ1
REQNUMBER: 21698
