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Premera Blue Cross Pharmacy Compliance Specialist in United States

Join Our Team: Do Meaningful Work and Improve People’s Lives

Our purpose, to improve customers’ lives by making healthcare work better, is far from ordinary. And so are our employees. Working at Premera means you have the opportunity to drive real change by transforming healthcare.

To better serve our customers, we’re creating a culture that promotes employee growth, collaborative innovation, and inspired leadership. We are committed to creating an environment where employees can do their best work and where best-in-class talent comes, stays, and thrives!

The Pharmacy Compliance Specialist will provide administrative oversight of drug lists (formulary) development and operations to assist in supporting Premera’s clinical and financial goals. The Pharmacy Compliance Specialist manages compliance with drug list requirements (National Committee for Quality Assurance (NCQA), Centers for Medicare & Medicaid Services (CMS), individual states, etc.), including oversight of all drug lists, web displays and coordination with pharmacy vendors. Coordinates Pharmacy and Therapeutics (P&T) and Pharmacy medical policy to ensure synchronization of processes.

What you'll do:

  • Provide for administrative oversight of drug list development, including support for the Pharmacy department in maintaining each of the company’s drug lists, maintaining online data, communication of updates and ensuring compliance with all drug list regulatory requirements.

  • Develop and maintain drug lists, web displays and search functionality and, in coordination with vendors such as Express Scripts and Managed Markets Insight and Technology (MMIT), conduct quality control checks and audits.

  • Prepare annual and quarterly drug (formulary) submissions to states and CMS.

  • Perform administrative functions for the Pharmacy and Therapeutics Committee, ensuring that medical and pharmacy policies pertaining to drug therapy are reviewed, approved and cataloged appropriately per state and federal regulation requirements related to drug list (formulary) and P&T functions.

  • Oversee pharmacy performance on NCQA standards, updating internal policies and procedures as needed to meet NCQA and other requirements. Update and develop procedures as needed.

  • Coordinate communication and audits of Pharmacy Benefit Management (PBM) vendor drug lists and provide administrative oversight of custom pharmaceutical rebate agreements.

  • Maintain knowledge of plan policies and benefits, current treatment procedures, and alternative resources.

What you'll bring:

  • A current and valid Washington state Pharmacy Technician license. (Required)

  • 5 years’ experience as a Pharmacy Technician. (Required)

  • 2 years’ experience working for a health plan or pharmacy benefit management organization supporting the operations of a pharmacy benefit. (Required)

  • Experience in health insurance industry.

What we offer

  • Medical, vision and dental coverage

  • Life and disability insurance

  • Retirement programs (401K employer match and pension plan)

  • Wellness incentives, onsite services, a discount program and more

  • Tuition assistance for undergraduate and graduate degrees

  • Generous Paid Time Off to reenergize

  • Free parking

Equal employment opportunity/affirmative action:

Premera is an equal opportunity/affirmative action employer. Premera seeks to attract and retain the most qualified individuals without regard to race, color, religion, sex, national origin, age, disability, marital status, veteran status, gender or gender identity, sexual orientation, genetic information or any other protected characteristic under applicable law.

If you need an accommodation to apply online for positions at Premera, please contact Premera Human Resources via email at careers@premera.com or via phone at 425-918-4785.

At Premera, we make healthcare work better. By focusing on improving our customers’ experience purposefully and serving their needs passionately, we make the process easier, less costly, and more positive. Through empathy and advocacy, we change lives.

As the leading health plan in the Pacific Northwest, we provide comprehensive health benefits and services to more than 2 million customers, from individuals to Fortune 100 companies. Our services include innovative programs focused on health management, wellness, prevention, and patient safety. We deliver these programs through health, life, vision, dental, disability, and other related products and services.

Premera Blue Cross is headquartered in Mountlake Terrace, WA, with operations in Spokane and Anchorage. The company has operated in Washington since 1933 and in Alaska since 1952. With more than 80 years of experience in the region, we deliver innovation, choice, and expertise.

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