Job Description
Job Description Your Role The Pharmacy Markets, Products, Analytics and Strategies (RxMAPS) team is responsible for leading and collaborating cross-functionally with key stakeholders across Pharmacy Strategy and Operations and Blue Shield. The RxMAPS team drives analytic strategy and performs clinical and business analyses necessary to provide consultations and strategic program recommendations to improve Cost of Health Care (COHC) and optimize outcomes. The Principal Pharmacist, Cost of Health Care will report to the Senior Manager, Rx Data Information Oversight and Reporting. In this role you will play a key role in leading and collaborating cross-functionally with key stakeholders across Blue Shield to drive analytic strategies and perform clinical and business analyses to improve COHC and optimize outcomes. You will monitor pharmacy and medical drug trends and the drug pipeline, and work with Actuarial and Finance teams to explain drivers of trend and identify opportunities for trend management. You will work with Enterprise Analytics to track and forecast COHC savings from pharmacy initiatives.
Responsibilities Your Work In this role, you will:
- Analyze and monitor prescription drug claims, medical drug claims, and program data to identify opportunities to improve quality and cost of healthcare
- Serve as a BSC Pharmacy Strategy and Operations contact and subject matter expert to stakeholders, and manage external relationships (vendors, clients) related to assigned work
- Proactively monitor pharmacy trends (e.g., brand and generic drug pipeline, new legislation and regulatory requirements, COHC initiatives)
- Provide pharmacy trend driver variance explanation (e.g., utilization, drug mix, unit cost)
- Present findings on drug pipeline, COHC initiative savings, and other drivers of trend to help drive COHC initiative ideation and strategy with cross-functional stakeholders
- Support Enterprise Analytics in developing COHC savings methodology and reporting to estimate, track, and forecast COHC initiative savings
- Work with Actuarial teams to enable accurate pharmacy pricing and trend forecast for quarterly Trendsetter processes
- Participate in lines of business finance and performance review meetings to understand and/or provide input on business drivers and objectives
- Work cross-functionally to support and drive on-time submission of select state and federally mandated reports
- Respond to trend surveys, request for proposals, and other data analytic requests
Qualifications Your Knowledge and Experience - Requires a Doctor of Pharmacy (PharmD) degree
- Requires a currently active and unrestricted California Registered Pharmacist (RPh) license
- Requires at least 4 years of experience in clinical pharmacy
- Requires at least 3 years of experience in pharmacy benefit management and managed care health plan working with large pharmacy and medical claims datasets
- Experience with other pharmacy data (e.g., pharmacy and medical rebates, pharmacy networks, prior authorization) is preferred
- Requires proficient data analytic skills with Microsoft Office (e.g., Excel and Access) and other data analytic tools (e.g., SQL, SAS, Snowflake, Tableau)
- Requires ability to leverage business and clinical knowledge to interpret health plan benefit utilization and pharmacy financial data and derive actionable recommendations for COHC savings initiatives
- Requires understanding of pharmacy data parameters available for analysis
- Requires ability to work independently with minimal oversight and direction from the manager
- Requires ability to work collaboratively with multi-disciplinary and cross functional teams
- Requires excellent presentation, verbal, and written skills with ability to understand and convey complex ideas to an audience with diverse backgrounds
- Requires the ability to work in a fast-paced environment with a "can do" attitude and solution-oriented approach to resolve challenges
About the Team 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: At Blue Shield of California and the Ascendiun Family of Companies, we believe in fostering a workplace environment that balances purposeful in-person collaboration with flexibility. As we continue to evolve our workplace model, our focus remains on creating spaces where our people can connect with purpose - whether working in the office or through a hybrid approach - by providing clear expectations while respecting the diverse needs of our workforce.
Two Ways of Working:
- Hybrid (Default): Work from a business unit-approved office at least two (2) times per month (for roles below Director-level) or once per week (for Director-level roles and above).Exceptions:
o Member-facing and approved out-of-state roles remain remote.
o Employees living more than 50 miles from their assigned offices are expected to work with their managers on a plan for periodic office visits.
o 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.
- On-Site: Work from a business unit-approved office an average of four (4) or more days a week.
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.
Job Tags
Full time, Part time, Work at office, Local area, Remote work, Home office, 1 day per week,