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CareFirst BlueCross BlueShield · 23 hours ago

Pharmacy Supply Chain Director- (Hybrid)

Baltimore, MD

Full-time

Hybrid

Senior Level, Lead/Staff

$158K/yr - $293K/yr

8+ years exp

CareFirst BlueCross BlueShield is seeking a Pharmacy Supply Chain Director responsible for leading financial and analytic functions within the Pharmacy Management department. This role ensures the organization maximizes contractual value by overseeing pharmacy rebates and network discounts, delivering accurate calculations, and enhancing data and analytics capabilities.

Health CareNon ProfitService Industry

No H1B

Responsibilities

Lead the end-to-end reconciliation of all pharmacy rebates, network discounts, and medical rebates to ensure contractual financial guarantees are met

Interpret multiple complex contract terms, conditions, definitions, and financial guarantees, translating them into claim-level mapping and reconciliation processes

Validate that each eligible claim receives the correct rebates and discounts, applying exclusions accurately based on contract terms

Monitor PBM compliance with timeliness and accuracy of payments

Identify and resolve discrepancies and proactively dispute as needed

Develop and maintain comprehensive reconciliation reporting for internal stakeholders and audit purposes

Maintain audit-ready processes and documentation with strong internal controls

Identify and report trends in financial performance to support strategic decision-making

Manage timely and accurate calculation and allocation of pharmacy rebates, network discounts, and medical rebates for self-insured ASO/CFA accounts

Interpret financial terms, conditions, definitions, and exclusions from ASO contracts and configure rules to ensure precise rebate and discount computations

Ensure contractual guarantees are met with transparency, fairness, timeliness, and accuracy

Collaborate with internal stakeholders, including Finance and Accounting to deliver reports and address client inquiries

Support financial audits by maintaining audit-ready methodologies, documentation, and allocation processes

Ensure medical rebate allocations are correctly integrated into ASO/CFA reporting

Continuously monitor and optimize calculation processes for efficiency and accuracy

Lead the pharmacy data management and analytics strategy to deliver accurate, reliable, and actionable insights

Build, maintain, and enhance the Pharmacy Performance Monitoring tool to provide operational and financial insights

Ensure robust data governance for integrity and readiness in decision-making

Drive proactive pharmacy insights through optimized dashboards, reporting, and analytics

Develop processes and documentation to embed data-driven decision-making and foster continuous improvement

Advance the future-state pharmacy analytics operating model to prepare for Synergies integration and enterprise-level insights

Maintain audit-ready analytics and governance processes aligned with internal standards

Provide strategic oversight across Pharmacy Supply Chain, Data, and Analytics functions

Lead, mentor, and develop high-performing staff across all areas

Partner with internal stakeholders including Finance, Legal, Compliance, Actuarial, and Clinical teams to ensure alignment and delivery of enterprise priorities

Communicate complex financial and analytic insights clearly to executive stakeholders

Foster a culture of accountability, accuracy, and continuous improvement

Qualification

Pharmacy Supply ChainPBM ContractingData GovernanceHealthcare FinancePharmacy AnalyticsManagement ExperienceInterpersonal SkillsCommunication SkillsNegotiation SkillsAdaptability

Required

Bachelor's Degree in Business Administration, Finance, Supply Chain Management, 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

8 years progressive experience in pharmacy within one or more of the following areas: PBM, healthcare finance, supply chain, or analytics

3 years management experience

Strong knowledge of PBM contracting, claims adjudication, pharmacy network management, formulary design, financial processes including rebates and discounts, and compliance regulations

Strong decision-maker with the ability to navigate complex business issues and make strategic choices in collaboration with the business sponsor

Expertise in Medicare, Medicaid, and Commercial pharmacy operations

Experience managing PBM implementations or transitions at a health plan, PBM, or consulting firm

Adaptability and resilience in a dynamic, fast-paced environment

Excellent interpersonal skills with the ability to influence and engage senior stakeholders and vendors

Highly organized and detail-oriented, with the ability to manage large-scale, multi-functional projects with executive visibility

Excellent communication, negotiation, stakeholder engagement, and relationship management skills, both verbal and written

Proven ability to manage timely and accurate reconciliation and allocation of rebates and network discounts within pharmacy supply chain

Experience in building and maintaining pharmacy data governance and analytic tools

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