Program Manager, Principal

Your Role

The Pharmacy Services team is redefining how Blue Shield offers high quality, affordable, safe and convenient access to necessary prescription drugs. The Principal Program Manager, Rx Claim Exchange will report to the Senior Director, Program and Project Management. In this role you will be the business Product Owner responsible for the Rx Claim Exchange Agile Product Team.  The Rx Claim Exchange Agile Product Team is one of many teams that makes up the Pharmacy Product Model.  You will work cross functionally with other Pharmacy Services teams, IT, and our Service Providers and external vendors to manage inbound and outbound claim data files, claim data APIs, and cloud and on-prem claim data sources, including new implementations, ongoing operations/enhancements, and incident management.

Your Work

In this role, you will:

• Operate at a strategic business level to ensures projects/programs are in line with Blue Shield of California strategic goals
• Consult with all levels including senior management, make recommendations, and influence decision-making
• Leverage cross-functional internal and external relationships to drive initiatives forward 
• Plan and implement multiple and extremely complex projects/programs spanning across business areas
• Determine key business issues, develop effective action plans and implement to successful conclusion
• Collaborate with cross functional pharmacy teams, IT, external Service Providers, and other external vendors to implement large-scale, complex enterprise applications requiring high performance and availability for pharmacy claim data
• Collaborate with cross functional pharmacy teams, IT, external Service Providers, and other external vendors to assess pharmacy claim data incidents and errors that can have negative impact on member experience, customer experience, Blue Shield reputation, and Cost of Health Care/Finance and enable effective and efficient resolution
• Manage, groom, and prioritize the Rx Claim Exchange Agile team backlog, direction, and oversight.  Additionally, work with the IT Pharmacy portfolio team within the Agile Product Model to contribute to the overall pharmacy vision and roadmap. 
• Review and create business and IT requirements, source-to-target-mapping, QA and User Acceptance Testing results and provide pharmacy business sign off for IT releases
• Perform as the business liaison to help connect the dots between business and IT to ensure effective communication of requirements, business needs, scope definition, issue resolution, impact and root cause analysis, and other such functions as assigned
• Invest in Rx Claim Exchange Product process improvements, utilizing data and organizational strategies to foster and influence change
• Serve as an advocate for the product team to Senior Leadership and provide/receive consultation with other Pharmacy Product Owners

Your Knowledge and Experience

• Requires a bachelor’s degree or equivalent experience
• Requires at least 10 years of prior relevant experience
• Requires experience working with Pharmacy Benefits Manager (PBMs) and pharmacy Claims, Membership, Prior Authorization, Benefits, Pharmacy Networks and Providers, Rebate, and other relevant data
• Demonstrates strong data analysis and data interpretation skills
• Demonstrates strong ability to influence, collaborate, and build relationships with key stakeholders, vendors, and cross-functional teams
• Possesses effective verbal and written communication skills including the ability to create business requirements and translate into technical deliverables
• Experience with Agile/Scrum processes and principals
• Experience as a Product Owner is a plus