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Resp & Qualifications

PURPOSE:

The Director, PBM Technical Operations provides leadership, oversight, and guidance to technical and operational support functions while analyzing their performance and makes recommendations for improvements. Directs the day-to-day business technical support of systems, and subsystems supporting end-to-end technical and operational accountability for all Pharmacy Benefit Management (PBM) related programs, technical design, implementations and deployments, and ongoing operational support. The Director provides corporate leadership, vision, and direction for the technical enablement of the key business functions including all benefit, eligibility, and transactions interfaces with CareFirst's third party PBM. The Director is responsible for all related support functions, ensuring support of the Company's business objectives and requirements of this key strategic corporate function.

ESSENTIAL FUNCTIONS:

+ Directs the day to day business technical resources for PBM Operations, support of systems and sub systems supporting benefits, eligibility, and accumulators. Includes: analysis, development and resolution of enterprise-wide user or customer problems and enhancement change requests; monitoring systems effectiveness and its impact on desired levels of productivity and quality; represents CF interests on such matters with external parties (customers, government agencies, other Plans, etc); and maintenance of critical processing files.

+ Responsible for performance evaluation, pay reviews and hire/termination decisions. Manage, coaches and mentors' staff to improve performance, ensure career growth and succession planning.

+ Direct the business analyst and project management functions which support SDLC functions, including design and definition of requirements, systems specifications, testing, and development of supporting user procedures or technical analyst administration activities which provide expert information system knowledge, coupled with expert business knowledge, to clients in order to solve complex business issues supporting CareFirst Corporate strategic goals.

+ Collaborates with Information Technology to ensure IT and business alignment; directs extensive interface and collaboration between business and IT personnel to define, prioritize and plan implementation of projects & day to day change management to meet internal and external commitments.

+ Influences and helps develop each Division and CareFirst strategic and tactical plans and therefore establishes, monitors, analyzes and initiates actions to improve key metrics, resource and budget plans and oversight, reporting mechanisms, and operating procedures impacting support of systems and Programs position is responsible for.

+ Researches and maintains strong knowledge of industry technology and related operational best practices in the areas of PBM Operations, transaction adjudication, and data management and reporting tools to champion, collaborate with or advise peers and executive management on the formulation and decision making of strategies, goals and recommendations that advance CF?s functional and expense management capabilities.

QUALIFICATIONS:

**Education Level:** Bachelor's Degree, Business Administration, IT or related field OR in lieu of a Bachelor's degree, an additional 4 years of relevant work experience is required in addition to the required work experience.

**Experience:** 8 years experience in an IT and/or PBM operational environment

3 years management experience

Knowledge, Skills and Abilities (KSAs)

+ Excellent communcation skills both written and verbal.

+ Ability to recognize, analyze, and solve a variety of problems.

+ Ability to analyze, organize, and prioritize work while meeting multiple deadlines.

+ Proficient in Microsoft Office applications,

+ Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence. Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging. **Licenses/Certifications** **Salary Range:** $140,000 - $259,875

Salary Range Disclaimer

The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. This compensation range is specific and considers factors such as (but not limited to) the scope and responsibilites of the position, the candidate's work experience, education/training, internal peer equity, and market and business consideration. It is not typical for an individual to be hired at the top of the range, as compensation decisions depend on each case's facts and circumstances, including but not limited to experience, internal equity, and location. In addition to your compensation, CareFirst offers a comprehensive benefits package, various incentive programs/plans, and 401k contribution programs/plans (all benefits/incentives are subject to eligibility requirements).

Department

2024-2026 PBM/Pharmacy RFP

Equal Employment Opportunity

CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.

Where To Apply

Please visit our website to apply: www.carefirst.com/careers

Federal Disc/Physical Demand

Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on health care programs.

PHYSICAL DEMANDS:

The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted.

Sponsorship in US

Must be eligible to work in the U.S. without Sponsorship.

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REQNUMBER: 21007