Summary
 

Why should you join the BlueCross BlueShield of South Carolina family of companies?

Other companies come and go, but for more than seven decades we’ve been part of the national landscape, with our roots firmly embedded in the South Carolina community. We are the largest insurance company in South Carolina … and much more. We are one of the nation’s leading administrators of government contracts. We operate one of the most sophisticated data processing centers in the Southeast. We also have a diverse family of subsidiary companies that allows us to build on a variety of business strengths. We deliver outstanding service to our customers. If you are dedicated to the same philosophy, consider joining our team!

Position Purpose:

The Pharmacy Administration and Oversight Director creates and manages Request for Proposal (RFP) projects of pharmacy benefit management (PBM) services for commercial, exchange, Medicare and Medicaid lines of business. Negotiates PBM agreements, Master Services Agreements (MSA), Statement of Work (SOW) and other legal agreements for pharmacy services. Supports pharmacy sales and renewal activities, providing RFP/RFR responses for oversight and contractual material in proposal preparation with existing and prospective self-funded group presentations. Negotiates PBM contract terms with commercial business self-funded groups for retail/mail order/specialty pharmacy service and pharmacy-carve out groups requesting specialty drug medical management rebate sharing services. Negotiates, and oversees Non-Disclosure Agreements associated with third party request for release of pharmacy data containing confidential information, (ii) requests from third parties to audit contract terms (iii) requests from self-funded customer to conduct market check evaluations. Provides formal contract management and oversight for the Corporate PBM agreements, MSAs and all associated pharmacy contracts. Monitors contract performance including performance guarantees, financial guarantees, and compliance with state and federal regulatory requirements specific to self-funded groups.

Description
 

Logistics:

This is a full-time position working (40-hours/week) Monday-Friday 8:00am – 5:00pm Onsite with Hybrid and/or Remote possible at Percival Road, Columbia SC, in an office environment with occasional travel.

What You’ll Do:

• CORPORATE CONTRACTING: Represent the company through the life cycle of PBM agreements services for retail/mail order/specialty pharmacy services for commercial, exchange, Medicare and Medicaid lines of business. This includes creating and managing RFPs, contract drafting including state and federal regulatory requirements, contract negotiations, contract interpretation, contract performance measurement against guaranteed terms, initiating renewal offers and amendments, responding to and resolving disputes and coordinating activities associated with termination or transition of PBM vendor.

• CLIENT SALES AND CONTRACTING: Represent the company through the life cycle of the pharmacy benefit management services extended to self-funded clients. This includes responding to contractual terms in RFPs, contract drafting including state and federal regulatory requirements, contract negotiations, contract interpretation, contract performance measurement against guaranteed terms, initiating renewal offers and amendments, resolving client disputes and coordinating activities associated with termination of contract. Negotiate and oversee Non-Disclosure Agreements associated with third party request for release of pharmacy data containing confidential information, reviews and facilitates requests from self-funded clients to audit contact terms; oversees market check rights and results in accordance with contract terms; and other self-funded client pharmacy related contracting initiatives

• CONTRACT OVERSIGHT: Management of a comprehensive contract management oversight program to measure ongoing compliance with contractual terms and guarantees for Corporate PBM vendors, third-party vendors and self-funded client groups.

• AUDITING: Lead audit activities at the corporate and group level, collaborate with vendors, consultants, clients and internal stakeholders. Lead recovery actions, with internal and external communications provided on findings.

• STRATEGY: Advise and lead discussions, in collaboration with pharmacy leadership, on vendor and client contract related matters, including potential liability and exposure, and disputes. Collaborate with enterprise counsel and Government Affairs staff on various matters relating to clients and the PBM business in general.

• CUSTOMER FOCUS: Operate in a strategic and pro-active manner to assist internal business customers in managing their relationships with clients, and managing the regulatory risk related to the provision of prescription drug benefits to client services.

To Qualify For This Position, You’ll Need:

• Required Education: Bachelor's in a job related field

• Degree Equivalency: 4 years job related work experience or Associate's and 2 years job related work experience

• Required Work Experience:

  • 8+ years of experience in contract management or detailed pharmacy oversight work experience.

  • 4+ years of previous management experience or 4+ years of equivalent military experience in grade E4 or above (may be concurrent with the 8+ years).

• Required Skills and Abilities:

  • Excellent analytical, critical-thinking, and problem-solving skills.

  • Ability to work in a highly changing environment.

  • Ability to persuade, negotiate, or influence.

  • Excellent presentation skills with strong attention to detail.

  • Demonstrated legal knowledge, leadership and sound strategic thinking skills.

  • Ability to effectively communicate verbally and in writing to all levels throughout the company and client base.

• Required Software and Tools: Microsoft Office

What We Prefer You To Have:

• Bachelor’s Degree STRONGLY PREFERRED

• Master’s Degree

• Exceptional attention to details

• Advanced Microsoft Office skills, specifically with Excel and Powerpoint, Sharepoint, and Teams

• Strong business acumen with advanced knowledge of the PBM industry.

• Demonstrated leadership ability in contracting and oversight, linking strategic goals into contractual terms.

• Excellent organization and project management skills with the ability to oversee multiple complex projects with competing deadlines.

• Able to quickly implement new business requirements without disruption of current responsibilities.

• Time management skills and the ability to work effectively in an independent setting.

• Ability to use complex mathematical calculations.

• Ability to train and manage a team in a remote environment.

• Twelve plus years of experience successfully leading teams in health-plan/healthcare/PBM contracting, auditing, oversight/compliance.

• Six plus years of previous management experience OR six years of equivalent military experience in grade E4 OR above (may be concurrent with the ten plus years).

• Experience working in a remote work environment

What We Can Do For You:

We offer our employees great benefits and rewards.  You will be eligible to participate in the benefits the first of the month following 28 days of employment.  

• Subsidized health plans, dental and vision coverage

• 401K retirement savings plan with company match

• Life Insurance

• Paid Time Off (PTO)

• On-site cafeterias and fitness centers in major locations

• Wellness program and healthy lifestyle premium discount

• Tuition assistance

• Service recognition

• Employee Assistance

• Discounts to movies, theaters, zoos, theme parks and more

What to Expect Next:

After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications.  This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements.

Management will be conducting interviews with those candidates who qualify, with prioritization given to those candidates who demonstrate the preferred qualifications.

We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer.

Some states have required notifications. Here's more information. 

Equal Employment Opportunity Statement

BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains Affirmative Action programs to promote employment opportunities for minorities, females, disabled individuals and veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations.

We are committed to working with and providing reasonable accommodations to individuals with physical and mental disabilities.

If you need special assistance or an accommodation while seeking employment, please e-mail [email protected] or call 1-800-288-2227, ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis.

 

We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer.

Some states have required notifications. Here's more information. 

Equal Employment Opportunity Statement

BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains Affirmative Action programs to promote employment opportunities for minorities, females, disabled individuals and veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations.

We are committed to working with and providing reasonable accommodations to individuals with physical and mental disabilities.

If you need special assistance or an accommodation while seeking employment, please e-mail [email protected] or call 1-800-288-2227, ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis.