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Senior Director Clinical Strategy, SMC

Company: 
BCBSA
CIty: 
Washington
State: 
DC
Occupational fields: 
Management
Employment type: 
Full time
Remote Position: 
No
Required degree level: 
Other

Job Description Summary

Synergie Medication Collective is a new medication contracting organization founded by a group of Blue Cross and Blue Shield affiliated companies to serve both Blues and select independent health plans. Synergie is focused on improving affordability and access to costly medical benefit drugs - ones that are injected or infused by a health care professional in a clinical setting - for nearly 100 million Americans.

The Sr. Director Clinical Strategy leads the overall clinical strategy and implementation, portfolio of clinical opportunity and tracking for specified therapeutic categories. This includes medical drug policy, cross benefit management, trend management, and medical drug management capabilities. This position will establish and maintain cross functional partnerships with capability owners to drive the identification, development and successful execution of Synergie Medication Collective's pharmacy programs. This position will be the subject matter expert for Synergie Medication Collective's clinical solutions, and specific therapeutic categories for both internal and external stakeholders, including competitive intelligence.

Responsibilities include but are not limited to:

  • Maintain competitive intelligence of best-in-class medical drug management solutions in the market, with a focus on clinical management through medical drug policy or other utilization management programs; additionally, strategies to manage medical drug using non-clinical, administrative, or other methods
  • Lead the development and implementation of strategies for the internal and external committee and serve as an internal SME to cross functional client teams and participate in client facing meetings to further translate and advise on the implementation of proposed strategies
  • Develop clinical and business solutions for the Synergie program specific therapeutic categories; oversee the development and implementation of product solutions
  • Partner with the following stakeholders for:
  • Analytics teams to manage/ monitor data in areas such as: trend/net trend, net ingredient cost, utilization % change, brand inflation, specialty network savings, formulary compliance, rebate/Rx, specialty network savings, utilization management (UM) drug savings.
  • Client Engagement teams in consulting on strategies and presenting specific solutions to Clients.
  • Pharmaceutical Trade Relations: for collaboration on new programs that may impact manufacturer contracting, manufacturer contract performance and other areas as needed
  • Clinical Program Development: serve as a partner for Synergie Medication Collective's UM policies design placement, pipeline, P&T committee recommendations, and maintenance of drug lists.
  • Strategize with Trade, Innovation, and Analytics teams to develop and assist with management of therapeutic category performance
  • Provide support to product team in development and maintenance of any Synergie Medication Collective's solution collateral

Required Education, Certifications and Experience:

  • Doctor of Pharmacy (PharmD) or Bachelor of Science Pharmacy degree and current pharmacist license in good standing with the State Board of Pharmacy in the state where the position is located
  • 8 years of work experience in health care, including health plan, health system, pharmacy experience in managed care or specialty pharmacy with 3 years minimum at a health plan or PBM experience in medical drug management
  • Must be eligible to work in the United States without need for work visa or residency sponsorship

Preferred Education, Certifications and Experience :

  • Ability to facilitate change
  • Ability to develop relationships and influence at all organizational levels
  • Demonstrated ability to distill complex concepts or situations into concise and compelling communications
  • Critical thinking skills and ability to anticipate issues and develop innovative solutions
  • Preferred Qualifications
  • Advanced degree or Certification in specific therapeutic category
  • Experience in commercial or government program medical drug management strategy
  • Minimum Physical Job Requirements
  • Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus

Make an impact on healthcare in America. A career with Blue Cross Blue Shield Association allows you to be part of the foundation that supports the 35 Blue Cross and Blue Shield companies nationwide, while protecting and strengthening the Blue Cross Blue Shield brand. Our work is helping provide greater access to cost-effective healthcare, improve the health of America and build stronger communities. With a commitment to diversity, equity and inclusion, we celebrate different cultures, languages, backgrounds and experiences while striving to advance health equity, and we want you to join Team BCBSA.

Accommodations:
Vision Accommodations, Hearing Accommodations, Neurodiversity, Learning, Mental Health, Mobility