Lead PBM Network Analyst/Management

Positions: Lead PBM Network Analyst/Management

Candidates from Approved States ONLY: DC, MD, VA, WV, NC, PA, DE, NY, NJ, TX, FL.

Work mode: 100% Remote

Interview Mode: 2 Video

Required Skills

- Education Level: Bachelor's Degree required. MBA preferred
- Education Details: Business Administration, Healthcare Management, Supply Chain Management, or related field.
- Experience: Previous experience leading a PBM health plan transition, 7+ years- experience in total in either pharmacy supply chain, pharmacy business operations, PBM operations, PBM contracting, pharmacy services, and supply chain management.

Mandatory Skills:
- Must have full knowledge around the financial components of PBM.
- 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.
- 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, multi-organizational projects with executive visibility.
- Ability to communicate at all organizational levels from individual contributor level to executive leaders. Excellent communication, negotiation, stakeholder engagement, and relationship management skills, both verbal and written