Director of UM Operations - Compliance

December 14

🇺🇸 United States – Remote

🌲 North Carolina – Remote

Although this job is listed in North Carolina, this company may be open to hiring remote in other states.

🏈 Ohio – Remote

Although this job is listed in Ohio, this company may be open to hiring remote in other states.

💵 $131.9k - $250.6k / year

⏰ Full Time

🔴 Lead

🚔 Compliance

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501 - 1000 employees

Founded 1997

🏛️ Government

📋 Compliance

Description

• Direct, manage and lead efforts that define and enable strategic and operational priorities for the Pharmacy group. • Lead staff responsible for accomplishing goals related to pharmacy operations, clinical and specialty pharmacy programs, opportunity analysis, solution design, provider/payer integration and vendor evaluation and management. • Provides expertise and insights for new services, operational improvements, and partnerships to drive pharmacy cost reductions and quality of care initiatives. • Champion innovation while identifying pharmacy related opportunities and collaborations that drive value for Blue Cross NC members. • Evaluates emerging pharmacy industry trends and the strategic needs of the department as it relates to overall business objectives. • Translates strategy into defined tactics, programs/projects, priorities and timelines and ensures alignment with Healthcare objectives and enterprise goals. • Directs the management of operational aspects of pharmacy services. • Oversees day-to-day operations of pharmacy benefits management and other related vendors to meet the needs of the membership and remain responsive to the company’s needs. • Evaluate and manage new and/or existing vendors and solution partners to align to BCNC’s strategic direction.

Requirements

• Bachelor’s degree and 10 years of experience in pharmacy benefits management, managed care, and/or strategic or product development. • OR PharmD/relevant Master’s degree (MBA/MHA) with 8 years of experience as stated above. • 5 years of leadership experience, leading people and/or complex, cross divisional projects or programs. • For some positions, a current pharmacy license is required.

Benefits

• Annual Incentive Bonus* • 401(k) with employer match • Paid Time Off (PTO) • Competitive health benefits and wellness programs