Sr Strategic Advisor, Specialty Pharmacy Networks

Remote Flex - North Carolina

Remote Flex - Mississippi

Remote Flex - South Carolina

Remote Flex - Texas

Remote Flex - Louisiana

Remote Flex - Kentucky

Remote Flex - Kansas

Remote Flex - Iowa

Hybrid Flex - Durham

Remote Flex - Indiana

Remote Flex - Arkansas

Remote Flex - Georgia

Remote Flex - Virginia

Remote Flex - Tennessee

Remote Flex - Pennsylvania

Remote Flex - Michigan

Remote Flex - Wisconsin

Remote Flex - South Dakota

Remote Flex - Florida

Remote Flex - Oklahoma

Remote Flex - Ohio

Remote Flex - Missouri

Remote Flex - Alabama

Full time

RQ0019116

Job Description

Acts as a senior member of the strategic function by contributing to the achievement of pharmacy affordability goals through specialty pharmacy network design, contracting strategy, network optimization, and innovative market-based pricing approaches. Leverages industry experience and expertise to evaluate emerging market opportunities, develop and implement network-based cost reduction strategies, and promote enterprise understanding of specialty pharmacy market dynamics to create sustainable competitive advantage and long-term affordability improvements.

• Proactively identify, analyze, evaluate, and implement specialty pharmacy network strategies, reimbursement models, and contracting opportunities that support affordability goals while maintaining member access, provider relationships, and regulatory compliance.

• Develop and execute specialty pharmacy network optimization strategies, including network design, performance management, pricing approaches, participation requirements, and market-based reimbursement methodologies.

• Support strategic planning, structured financial and qualitative analysis, business case development, and network evaluations to inform contracting decisions, network investments, and affordability initiatives.

• Translate complex network, reimbursement, and market dynamics into clear strategic recommendations and actionable plans for internal stakeholders, including senior leadership.

• Present network strategies, performance metrics, affordability opportunities, contracting recommendations, and impact assessments to internal audiences at all levels, including executive leadership.

• Collaborate with and support other departments across the enterprise on both common initiatives and unique ventures, acting as a subject matter expert in specialty pharmacy network strategy, contracting, reimbursement methodologies, and affordability solutions.

• Identify, analyze, and monitor industry, regulatory, technology, provider, PBM, and market trends that influence specialty pharmacy network performance, reimbursement economics, access models, and overall cost management.

• Engage with specialty pharmacies, PBMs, vendor, consultants, vendors, providers, and other external partners to evaluate opportunities, resolve strategic challenges, and support development of innovative affordability solutions.

• Organize, synthesize, and communicate progress, recommendations, and outcomes across the specialty pharmacy network strategy portfolio to support alignment, accountability, and informed decision-making.

• Utilize expertise to advance network strategy, contracting, reimbursement, and affordability capabilities, continuously improving how network-based solutions are developed, evaluated, and implemented to achieve sustainable unit cost reduction.

Hiring Requirements

• Bachelor's degree or advanced degree (where required)

• 5+ years of experience in related field.

• In lieu of degree, 7+ years of experience in related field.

Salary Range

At Blue Cross NC, we take great pride in a fair and equitable compensation package that reflects market-price and our starting salaries are typically planned near the middle of the range listed. Compensation decisions are driven by factors including experience and training, specialized skill sets, licensure and certifications and other business and organizational needs. Our base salary is part of a robust Total Rewards package that includes an Annual Incentive Bonus*, 401(k) with employer match, Paid Time Off (PTO), and competitive health benefits and wellness programs.

*Based on annual corporate goal achievement and individual performance.

$89,174.00 - $142,679.00

Skills

Healthcare Consulting, Healthcare Financial Management, Healthcare Industry, Healthcare Innovation, Healthcare Management, Healthcare Reimbursement, Healthcare Strategic Planning, Health Outcomes, Medical Reimbursement, Performance Metrics, Physician Reimbursement, Project Management, Provider Reimbursement, Reimbursement, Reporting and Analysis

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About Us

It's an exciting time to work at Blue Cross and Blue Shield of North Carolina (Blue Cross NC). Health care is changing, and we're leading the way. We offer more than health insurance our customers can count on. We’re committed to better health and better health care − in our communities and beyond. Our employees bring energy and creativity to the workplace, and it shows in our innovative approach to improving the health and well-being of North Carolinians.

Blue Cross NC is a fully taxed, not-for-profit company headquartered in Durham, North Carolina. We serve more than 4.3 million members, and we employ more than 5,000 people across the country who are passionate about making health care better for all.

Help us lead the charge for better health care by joining our award-winning team. Discover tremendous opportunities with us to do challenging and rewarding work. Opportunities that can lead you to a fulfilling career, work that can help others lead healthier, happier lives.

Authorization to Work in the United States

We use E-verify to confirm authorization to work in the United States. To learn more about E-Verify, including your rights and responsibilities, please visit E-Verify Overview (https://www.e-verify.gov/employees/e-verify-overview) for English or Visión General de E-Verify (https://www.e-verify.gov/es/empleados/vision-general-de-e-verify) for Español.

Request Accommodations

Blue Cross NC provides reasonable accommodations to applicants with disabilities. If you need a reasonable accommodation for any part of the application, hiring process, or have technical issues that prevent you from completing your application please notify HR at [email protected] .

Blue Cross NC is a Hybrid Flex company. Whether the role is Hybrid Flex or Remote Flex depends on the nature of the work and distance from our Durham headquarters. We welcome candidates from outside the local area and in any of our approved states:

Alabama, Arizona, Arkansas, Colorado, Florida, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Michigan, Mississippi, Missouri, North Carolina, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Wisconsin, and Wyoming