Why Wellmark: We are a mutual insurance company owned by our policy holders across Iowa and South Dakota, and we’ve built our reputation on over 80 years’ worth of trust. We are not motivated by profits. We are motivated by the well-being of our friends, family, and neighbors–our members. If you’re passionate about joining an organization working hard to put its members first, to provide best-in-class service, and one that is committed to sustainability and innovation, consider applying today!

Help us lead change and transform Wellmark's business!

The health care industry is changing, and Wellmark is working to help change it for the better. We recognize that our members deserve health care with a focus on quality. We also recognize that health care is complex. We’ve embarked on a journey to support our members use and navigate the health care system in order to help them make clear, informed decisions, and we’re also ensuring that we take a team-centric approach when working with and in support of our members. The work that our diverse business and care teams are doing in collaboration with our health care partners will create these changes, all while working to minimize health care costs.

Learn more about our unique benefit offerings here.

You can also learn more about working at Wellmark here.

Use your strengths as a Director of Pharmacy Pricing & Operations at Wellmark!

About the role: As Director of Pharmacy Pricing & Operations, you will be a true change leader and help guide the vision and strategic direction for the Pricing and Operation teams at Wellmark. As a leader of others, you will directly impact the success, growth, and development of team members by setting clear expectations, coaching to each team member’s strengths, and fostering a team-centric work environment. Being a role model in behaviors that demonstrate Wellmark’s Leader Success Expectations and inclusion are essential. You will serve as a subject matter expert in all areas of pharmacy operations and pricing, including claims auditing and advancement of rebate performance and profitability for both clients and the plan. You will collaborate with other division leaders, such as Technology and Operations, to create and deliver a roadmap for success within Pharmacy Operations.

What does it take to make the cut? You believe health care can be better and are passionate about finding ways to influence this important work. You are proactive, analytical, innovative, and partner effectively with internal and external stakeholders. You have substantial experience in managed care pharmacy operations, pharmaceutical contract negotiation, and the systems and tools necessary to maximize drug affordability and operational excellence. The unknown and opportunity to build something from scratch excites you, because to you it is just another challenge to overcome on the path of rewarding, strategic work. You are also an experienced people-leader who believes mentorship and team member growth is the key to success. You love to teach and understand the benefits of transparent, dedicated leadership, because your team members’ individual achievements mean success for Wellmark.

Required:

• Bachelor's degree in Pharmacy or PharmD.
• Active & unrestricted Pharmacy license in Iowa or South Dakota (individual must be licensed in the state in which they reside) or ability to obtain within 6 months from date of hire.
• 8 years of experience in managed care which may include pharmaceutical market access, pharmacy benefit management, formulary, and rebate strategy setting, or with a focus on financial strategy and pharmacy operations. Minimum of 3 years of experience in pharmaceutical manufacturer pricing strategy.
• Track record of success leading end-to-end management of complex programs from inception through execution and ongoing optimization.
• Broad understanding of the health care delivery system and pharmacy trends, and methods to impact those trends, including program design and financing.
• Demonstrated leadership role managing rebate contracting and/or rebate aggregator vendor management. Demonstrated work in pharmacy operations and track record of promotion into higher operations position(s) within PBM and/or health plan.
• Demonstrated leadership experience, including building/developing high performing leaders and leaders of teams that consistently deliver value-added results.
• Demonstrated knowledge of accreditation standards, PBM contracts, Part D rules and regulations. Demonstrated understanding of pharmaceutical commercial and government pricing (AMP, Best Price, ASP, 340B).
• Humanistic approach to leadership with experience in building, leading, motivating, evaluating teams and complex programs. Collaborative leader; experience building consensus and influencing decisions through the development and maintenance of effective working relationships with executive management.
• Experience manipulating and analyzing data from large databases using SAS, SQL or other appropriate software. Ability to effectively articulate complex information across all levels of an organization, including senior leadership and non-clinical/technical audiences.
• Executive presence and ability to deliver a variety of messages to a variety of audiences including board presentations.
• Strong ability to leverage industry knowledge, technical expertise, and relationship building skills to build rapport, credibility, and collaborative partnerships with clinical peers, leaders, and stakeholders; applies skillful consulting abilities to influence corporate decisions
• Is forward-thinking, exhibits the ability to learn quickly; advocates and leads change efforts; analyzes successes and failures for improvement opportunities; enjoys challenges. Works well under pressure while remaining adaptable, open to feedback and focused during unanticipated challenges.
• Proficiency with the Microsoft Windows Office Suite, including Word and Excel.
• Travel required up to 25% to meet with vendors, clients and attend conferences.

Preferred:

• MBA or Master’s degree preferred

a. Direct and oversee operations functions of the administration and delivery of pharmacy benefits. Work closely in collaboration with Procurement in managing PBM service and guarantees to Wellmark.
b. Develop processes to understand and drive management of rebate impacts of formulary strategies, pharma contract changes, public policy changes, and other market events. Develop, document, and communicate policies and procedures and process flows related to pharmacy benefit administration.
c. Responsible for leadership and oversight of a team focused on the identification and evaluation of strategies to optimize rebate value in response to pharmaceutical market events.
d. Lead a team that designs, develops, and delivers analytic solutions to inform rebate strategies and evaluate opportunities that will improve rebate and net cost performance.
e. Responsible for communicating analytical results and actionable trade insights to Pharmacy Services leadership as well as to other senior business leaders and must be able to clearly explain technical concepts to leaders with highly varied levels of technical background.
f. Provide day-to-day leadership of human resources, primarily focusing on leader and employee coaching, development, performance improvement, coordination and budgeting for pharmacy operation and finance/contracting team. Drive and produce results that are effective, accurate, and timely. Align work with department strategy and be on target to meet member, business and stakeholder needs.
g. Ensure that all Pharmacy-Health Services policy standards and business processes comply with regulations and sub-regulatory guidance related to pharmacy benefit management and administration and that there is alignment with corporate values that support and enhance the Pharmacy team functions and quality of healthcare services. Ensure policy is based on accepted standards of care.
h. Participate in the development of content in marketing and member materials including the drug formulary, Provider Directory, Evidence of Coverage, Summary of Benefits, Explanation of Benefits and member and provider communications. Responsible for implementing and maintaining quality assurance practices as they relate to written documentation.
i. Provide leadership and guidance, or participate in, various pharmacy benefit manager committees and project teams to ensure ongoing compliance, pharmacy benefit management and administration.
j. Provide pharmacy benefit operational leadership and serve as a respected SME for cross organization programs that involve pharmacy including health services, care management, medically benefited drug management and pricing strategies, member experience teams and Wellmark’s Payment Integrity Office.
k. Other duties as assigned.

This job requires a non-compete agreement.

An Equal Opportunity Employer

The policy of Wellmark Blue Cross Blue Shield is to recruit, hire, train and promote individuals in all job classifications without regard to race, color, religion, sex, national origin, age, veteran status, disability, sexual orientation, gender identity or any other characteristic protected by law.

Applicants requiring a reasonable accommodation due to a disability at any stage of the employment application process should contact us at careers@wellmark.com