Team Leader, Pharmacy Quality Specialist
Team Leader, Pharmacy Quality Specialist
Locations: Remote - North Carolina
Full time
Job Description
We’re seeking a Team Leader, Pharmacy Quality Specialist to join the Pharmacy Quality team within our Government Pharmacy department. You will provide direction and ongoing coordination of support staff responsible for accomplishing goals related to clinical functions of pharmacy operations, pharmacy programs (including government programs – i.e. Medicare) provider/payer integration and vendor evaluation and management. Support new services, operational improvements, and partnerships to drive pharmacy cost reductions and quality of care initiatives. Partner effectively with other business areas to champion innovation while implementing and managing pharmacy related opportunities and collaborations that drive value for Blue Cross NC members. This position will also support Medicare Star and other quality initiatives.
Note: North Carolina–based candidates strongly preferred
What You'll Do
• Support divisional strategies and assist with departmental implementation activities to produce favorable medical expense, administrative pricing and/or appropriate reductions in prescription drug costs PMPM.
• Maintain awareness of trends, developments, and governmental regulations in managed health care organizations and product line(s) under leadership purview.
• Act as a technical resource for team members and other departments, providing assistance and guidance on system issues, pharmacy policies, benefits, and work processes and procedures specific to departmental needs.
• Identify trends, determine root causes, and take action to resolve issues and initiate necessary process and procedural changes to meet the needs of the membership and remain responsive to the company’s needs to achieve customer expectations and financial and performance targets.
• Ensure pharmacy programs and processes are compliant in accordance with all applicable regulations of CMS, State, Federal, and other accrediting bodies; develop and implement corrective action plans whenever necessary.
• Coordinate work, monitor productivity of departmental staff and multi-disciplinary projects teams in the implementation of pharmacy programs for assigned line(s) of business
• Represent the pharmacy department on corporate projects or committees, as well as with vendors, providers and customers as the pharmacy expert when needed.
• Support Medicare Star and other quality initiatives.
What You Bring
• Bachelor or Advanced Degree where required
• 5+ years of experience
• In lieu of degree, 7+ years of experience
• Active Pharmacy Technician license in the state of North Carolina (PTCB: Pharmacy Technician Certification Board - Nationally Accredited Certification Exam)
Bonus Points (preferred qualifications)
• North Carolina–based candidates strongly preferred
• Strong proficiency in Excel
• Proven ability to lead and develop teams, foster cross‑functional collaboration, and coach employees to achieve performance expectations
What You’ll Get
The opportunity to work at the cutting edge of health care delivery with a team that’s deeply invested in the community
• Work-life balance, flexibility, and the autonomy to do great work
• Medical, dental, and vision coverage along with numerous health and wellness programs
• Parental leave and support plus adoption and surrogacy assistance
• Career development programs and tuition reimbursement for continued education
• 401k match including an annual company contribution
Salary Range
At Blue Cross NC, we take great pride in a fair and equitable compensation package that reflects market-price and our starting salaries are typically planned near the middle of the range listed. Compensation decisions are driven by factors including experience and training, specialized skill sets, licensure and certifications and other business and organizational needs. Our base salary is part of a robust Total Rewards package that includes an Annual Incentive Bonus*, 401(k) with employer match, Paid Time Off (PTO), and competitive health benefits and wellness programs.
• Based on annual corporate goal achievement and individual performance.
$60,907.00 - $97,452.00
Skills
Detail-Oriented, Government Regulation, Leadership, Patient Care, Performance Improvements, Pharmacy, Pharmacy Operations, Policy Development, Process Improvements, Quality Assurance (QA), Quality Improvement, Regulatory Compliance, Risk Management, Time Management
JOB ALERT FRAUD: We have become aware of scams from individuals, organizations, and internet sites claiming to represent Blue Cross and Blue Shield of North Carolina in recruitment activities in return for disclosing financial information. Our hiring process does not include text-based conversations or interviews and never requires payment or fees from job applicants. All our career opportunities are published on https://bcbsnc.wd5.myworkdayjobs.com/en-US/BCBSNC. If you have already provided your personal information that you suspect is fraudulent activity, please report it to your local authorities. Any fraudulent activity should be reported to: [email protected].
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Locations: Remote - North Carolina
Full time
Job Description
We’re seeking a Team Leader, Pharmacy Quality Specialist to join the Pharmacy Quality team within our Government Pharmacy department. You will provide direction and ongoing coordination of support staff responsible for accomplishing goals related to clinical functions of pharmacy operations, pharmacy programs (including government programs – i.e. Medicare) provider/payer integration and vendor evaluation and management. Support new services, operational improvements, and partnerships to drive pharmacy cost reductions and quality of care initiatives. Partner effectively with other business areas to champion innovation while implementing and managing pharmacy related opportunities and collaborations that drive value for Blue Cross NC members. This position will also support Medicare Star and other quality initiatives.
Note: North Carolina–based candidates strongly preferred
What You'll Do
• Support divisional strategies and assist with departmental implementation activities to produce favorable medical expense, administrative pricing and/or appropriate reductions in prescription drug costs PMPM.
• Maintain awareness of trends, developments, and governmental regulations in managed health care organizations and product line(s) under leadership purview.
• Act as a technical resource for team members and other departments, providing assistance and guidance on system issues, pharmacy policies, benefits, and work processes and procedures specific to departmental needs.
• Identify trends, determine root causes, and take action to resolve issues and initiate necessary process and procedural changes to meet the needs of the membership and remain responsive to the company’s needs to achieve customer expectations and financial and performance targets.
• Ensure pharmacy programs and processes are compliant in accordance with all applicable regulations of CMS, State, Federal, and other accrediting bodies; develop and implement corrective action plans whenever necessary.
• Coordinate work, monitor productivity of departmental staff and multi-disciplinary projects teams in the implementation of pharmacy programs for assigned line(s) of business
• Represent the pharmacy department on corporate projects or committees, as well as with vendors, providers and customers as the pharmacy expert when needed.
• Support Medicare Star and other quality initiatives.
What You Bring
• Bachelor or Advanced Degree where required
• 5+ years of experience
• In lieu of degree, 7+ years of experience
• Active Pharmacy Technician license in the state of North Carolina (PTCB: Pharmacy Technician Certification Board - Nationally Accredited Certification Exam)
Bonus Points (preferred qualifications)
• North Carolina–based candidates strongly preferred
• Strong proficiency in Excel
• Proven ability to lead and develop teams, foster cross‑functional collaboration, and coach employees to achieve performance expectations
What You’ll Get
The opportunity to work at the cutting edge of health care delivery with a team that’s deeply invested in the community
• Work-life balance, flexibility, and the autonomy to do great work
• Medical, dental, and vision coverage along with numerous health and wellness programs
• Parental leave and support plus adoption and surrogacy assistance
• Career development programs and tuition reimbursement for continued education
• 401k match including an annual company contribution
Salary Range
At Blue Cross NC, we take great pride in a fair and equitable compensation package that reflects market-price and our starting salaries are typically planned near the middle of the range listed. Compensation decisions are driven by factors including experience and training, specialized skill sets, licensure and certifications and other business and organizational needs. Our base salary is part of a robust Total Rewards package that includes an Annual Incentive Bonus*, 401(k) with employer match, Paid Time Off (PTO), and competitive health benefits and wellness programs.
• Based on annual corporate goal achievement and individual performance.
$60,907.00 - $97,452.00
Skills
Detail-Oriented, Government Regulation, Leadership, Patient Care, Performance Improvements, Pharmacy, Pharmacy Operations, Policy Development, Process Improvements, Quality Assurance (QA), Quality Improvement, Regulatory Compliance, Risk Management, Time Management
JOB ALERT FRAUD: We have become aware of scams from individuals, organizations, and internet sites claiming to represent Blue Cross and Blue Shield of North Carolina in recruitment activities in return for disclosing financial information. Our hiring process does not include text-based conversations or interviews and never requires payment or fees from job applicants. All our career opportunities are published on https://bcbsnc.wd5.myworkdayjobs.com/en-US/BCBSNC. If you have already provided your personal information that you suspect is fraudulent activity, please report it to your local authorities. Any fraudulent activity should be reported to: [email protected].
Apply tot his job
Apply To this Job