Managing Director, Clinical Pharmacy Strategy and Execution
BlueCross BlueShield of Tennessee, Chattanooga, Tennessee, United States, 37402
Clinical Pharmacy Leadership
Provides strategic leadership for clinical pharmacy initiatives across all lines of business. Oversee formulary, criteria, and prior authorization activities to ensure timely, compliant, and high-quality service delivery. Accountable for monitoring drug utilization trends, guiding performance standards, and ensuring regulatory compliance to support affordability and member outcomes. Job Responsibilities
Clinical Strategy Oversight: Lead the strategic direction, development, and execution of drug management programs, ensuring alignment with enterprise goals and regulatory requirements. Formulary & Coverage Review Program Management: Direct leadership staff responsible for formulary creation, criteria development and maintenance, prior authorization evaluations, and utilization management monitoring. Policy & Accreditation Governance: Oversee development and maintenance of clinical pharmacy policies and ensure compliance with accreditation standards (e.g., URAC, NCQA, CMS). Leadership Development: Lead and develop a high-performing team, fostering a culture of accountability, engagement, and continuous improvement, and professional growth. Cross-Functional Collaboration: Coordinate with pharmacy benefit strategy leaders and corporate stakeholders to deliver competitive and cost-effective clinical services. Audit Readiness: Lead audit preparation and compliance initiatives to ensure coverage review operations meet internal and external standards. Innovation & Value Delivery: Ensure clinical functions meet expectations for value and affordability, driving continuous improvement and market responsiveness. Job Qualifications
Education Doctor of Pharmacy (PharmD) degree required Experience Minimum 10 years of managed care, PBM, and/or clinical experience required Minimum 5 years of supervisory/leadership responsibilities required Skills/Certifications Licensed in Tennessee to practice pharmacy, or eligible for licensure in the state of Tennessee to practice pharmacy Ability to lead coverage review operations and ensure compliance Expertise in policy development and audit readiness Skill in driving process improvements for service quality Strength in cross-functional collaboration with pharmacy and corporate teams Leadership in building and mentoring operational teams BCBST will recruit, hire, train and promote individuals in all job classifications without regard to race, religion, color, age, sex, national origin, citizenship, pregnancy, veteran status, sexual orientation, physical or mental disability, gender identity, or any other characteristic protected by applicable law. Further information regarding BCBST's EEO Policies/Notices may be found by reviewing the following page: BCBST's EEO Policies/Notices BlueCross BlueShield of Tennessee is not accepting unsolicited assistance from search firms for this employment opportunity. All resumes submitted by search firms to any employee at BlueCross BlueShield of Tennessee via-email, the Internet or any other method without a valid, written Direct Placement Agreement in place for this position from BlueCross BlueShield of Tennessee HR/Talent Acquisition will not be considered. No fee will be paid in the event the applicant is hired by BlueCross BlueShield of Tennessee as a result of the referral or through other means.
Provides strategic leadership for clinical pharmacy initiatives across all lines of business. Oversee formulary, criteria, and prior authorization activities to ensure timely, compliant, and high-quality service delivery. Accountable for monitoring drug utilization trends, guiding performance standards, and ensuring regulatory compliance to support affordability and member outcomes. Job Responsibilities
Clinical Strategy Oversight: Lead the strategic direction, development, and execution of drug management programs, ensuring alignment with enterprise goals and regulatory requirements. Formulary & Coverage Review Program Management: Direct leadership staff responsible for formulary creation, criteria development and maintenance, prior authorization evaluations, and utilization management monitoring. Policy & Accreditation Governance: Oversee development and maintenance of clinical pharmacy policies and ensure compliance with accreditation standards (e.g., URAC, NCQA, CMS). Leadership Development: Lead and develop a high-performing team, fostering a culture of accountability, engagement, and continuous improvement, and professional growth. Cross-Functional Collaboration: Coordinate with pharmacy benefit strategy leaders and corporate stakeholders to deliver competitive and cost-effective clinical services. Audit Readiness: Lead audit preparation and compliance initiatives to ensure coverage review operations meet internal and external standards. Innovation & Value Delivery: Ensure clinical functions meet expectations for value and affordability, driving continuous improvement and market responsiveness. Job Qualifications
Education Doctor of Pharmacy (PharmD) degree required Experience Minimum 10 years of managed care, PBM, and/or clinical experience required Minimum 5 years of supervisory/leadership responsibilities required Skills/Certifications Licensed in Tennessee to practice pharmacy, or eligible for licensure in the state of Tennessee to practice pharmacy Ability to lead coverage review operations and ensure compliance Expertise in policy development and audit readiness Skill in driving process improvements for service quality Strength in cross-functional collaboration with pharmacy and corporate teams Leadership in building and mentoring operational teams BCBST will recruit, hire, train and promote individuals in all job classifications without regard to race, religion, color, age, sex, national origin, citizenship, pregnancy, veteran status, sexual orientation, physical or mental disability, gender identity, or any other characteristic protected by applicable law. Further information regarding BCBST's EEO Policies/Notices may be found by reviewing the following page: BCBST's EEO Policies/Notices BlueCross BlueShield of Tennessee is not accepting unsolicited assistance from search firms for this employment opportunity. All resumes submitted by search firms to any employee at BlueCross BlueShield of Tennessee via-email, the Internet or any other method without a valid, written Direct Placement Agreement in place for this position from BlueCross BlueShield of Tennessee HR/Talent Acquisition will not be considered. No fee will be paid in the event the applicant is hired by BlueCross BlueShield of Tennessee as a result of the referral or through other means.