Job Description

Acts as a senior member of the strategic function by contributing to the achievement of pharmacy affordability goals through specialty pharmacy network design, contracting strategy, network optimization, and innovative market-based pricing approaches. Leverages industry experience and expertise to evaluate emerging market opportunities, develop and implement network-based cost reduction strategies, and promote enterprise understanding of specialty pharmacy market dynamics to create sustainable competitive advantage and long-term affordability improvements.

• Proactively identify, analyze, evaluate, and implement specialty pharmacy network strategies, reimbursement models, and contracting opportunities that support affordability goals while maintaining member access, provider relationships, and regulatory compliance.
• Develop and execute specialty pharmacy network optimization strategies, including network design, performance management, pricing approaches, participation requirements, and market-based reimbursement methodologies.
• Support strategic planning, structured financial and qualitative analysis, business case development, and network evaluations to inform contracting decisions, network investments, and affordability initiatives.
• Translate complex network, reimbursement, and market dynamics into clear strategic recommendations and actionable plans for internal stakeholders, including senior leadership.
• Present network strategies, performance metrics, affordability opportunities, contracting recommendations, and impact assessments to internal audiences at all levels, including executive leadership.
• Collaborate with and support other departments across the enterprise on both common initiatives and unique ventures, acting as a subject matter expert in specialty pharmacy network strategy, contracting, reimbursement methodologies, and affordability solutions.
• Identify, analyze, and monitor industry, regulatory, technology, provider, PBM, and market trends that influence specialty pharmacy network performance, reimbursement economics, access models, and overall cost management.
• Engage with specialty pharmacies, PBMs, vendor, consultants, vendors, providers, and other external partners to evaluate opportunities, resolve strategic challenges, and support development of innovative affordability solutions.
• Organize, synthesize, and communicate progress, recommendations, and outcomes across the specialty pharmacy network strategy portfolio to support alignment, accountability, and informed decision-making.
• Utilize expertise to advance network strategy, contracting, reimbursement, and affordability capabilities, continuously improving how network-based solutions are developed, evaluated, and implemented to achieve sustainable unit cost reduction.

Hiring Requirements

• Bachelor's degree or advanced degree (where required)

• 5+ years of experience in related field.

• In lieu of degree, 7+ years of experience in related field.

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.
 

$89,174.00 - $142,679.00

Skills

Healthcare Consulting, Healthcare Financial Management, Healthcare Industry, Healthcare Innovation, Healthcare Management, Healthcare Reimbursement, Healthcare Strategic Planning, Health Outcomes, Medical Reimbursement, Performance Metrics, Physician Reimbursement, Project Management, Provider Reimbursement, Reimbursement, Reporting and Analysis

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