PBM Strategy and Implementation Consultant

JOB TITLE: PBM Strategy and Implementation Consultant

REMOTE

Exp: 18+yrs

Once perm on site 2-3 time a MONTH if not local cost will be covered.

MUST HAVE:

At least 1 PBM implementation from a hands-on perspective

Must be an executive level person that works on Business side matrixed to IT and Vendors

Must Understand the Financial Components, Operations, Network, Claims etc for a PBM

Strong Leadership and executive presence

Commercial PBM Experience (medicare and Medicaid are nice to have)

This role requires deep expertise in pharmacy supply chain financial management, PBM transitions, and pharmacy operations. The successful candidate will be responsible for a new pharmacy supply chain implementation and PBM transition, including managing execution activities, aligning stakeholders, contract management, vendor relationship management, and driving business readiness. Project Leadership & Accountability
Manage business execution team, ensuring alignment of team efforts with goals, objectives, and timelines.
Collaborate with the business sponsor, IT lead, PMO, and vendor partners to provide leadership and strategic direction, ensuring timely and successful delivery of business-related milestones.
Make key business decisions in partnership with the business sponsor. Contracts & Vendor Management:
Negotiate and manage PBM and supply chain contracts and Statements of Work (SOWs) with vendors, ensuring that contractual obligations are met and deliverables are aligned with business needs.
Manage vendor performance, working with the PMO, IT, and Operations teams to address any issues or risks that arise during implementation. Value Story Development and Communication
Develop and validate the value story for the PBM supply chain model, including calculating and quantifying the financial and investment value to the organization.
Work closely with the business sponsor to ensure the value story reflects the broader organizational impact, including cost savings, efficiency improvements, and enhanced service delivery.
Regularly update stakeholders on the realized value, change in value and adjusting strategies where necessary. Cross-functional Collaboration: and Business Readiness:
Collaborate with the IT Lead, PMO, Operations, vendor partners, and other departments to ensure seamless integration of business processes with the PBM supply chain model.
Act as the liaison between business stakeholders and project teams, translating business requirements into actionable tasks and ensuring alignment across all parties.
Facilitate business-focused meetings to discuss project status, issues, risks, and decisions with key stakeholders.
Work closely with the PMO office, IT, Operations, and vendors to prepare for net new roles and functions and support business readiness efforts, including ensuring effective communication, training, and documentation to prepare impacted teams for the transition. Risk Management & Performance Optimization:
Identify opportunities for operational improvements and provide recommendations to optimize business processes, enhance service delivery, and drive cost savings and efficiencies
Proactively identify and manage business related risks and issues, escalating as necessary to ensure timely resolution and minimize disruptions.
Work collaboratively with cross-functional teams and vendor partner, to develop and implement mitigation plans and corrective actions as needed. To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Education Level: Bachelor's Degree
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. In Lieu of Education In lieu of a Bachelor's degree, an additional 4 years of relevant work experience is required in addition to the required work experience. Preferred Qualifications
MBA or other graduate degree in business related field Knowledge, Skills and Abilities (KSAs) Proficiency 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

Mandatory Skills:
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.