Product Manager with a Background in PBM(Pharmacy Benefits Management)

Position Overview

Experienced Senior Product Manager with deep PBM expertise to lead strategy, development, and optimization of pharmacy benefit products, including claims processing, formulary management, rebate optimization, and member/provider experience.

Key Responsibilities

Product Strategy & Vision

·       Define and execute PBM product roadmap aligned with business and regulatory goals

·       Identify market opportunities and competitive positioning

·       Align product strategy with executive leadership priorities

PBM Domain Leadership

·       Lead claims adjudication, formulary management, rebate/pricing strategy

·       Oversee pharmacy network and utilization management workflows

·       Ensure compliance with CMS, HIPAA, and regulatory standards

Product Development & Execution

·       Own full product lifecycle from concept to launch

·       Translate requirements into user stories and specs

·       Partner with engineering, UX, data, and QA teams

·       Drive Agile practices (sprints, backlog, releases)

Stakeholder Engagement

·       Collaborate with clinical, operations, compliance, finance, and sales teams

·       Act as liaison between business and technology teams

·       Engage clients and vendors for requirements and validation

Data & Performance

·       Define KPIs (cost savings, claim accuracy, member satisfaction)

·       Use analytics to drive decisions and improvements

Client Focus

·       Understand client needs around cost, experience, and compliance

·       Support RFPs, demos, and presentations

·       Translate feedback into enhancements

Required Qualifications

·       Bachelor’s degree (MBA preferred)

·       7–10+ years product management with PBM/healthcare experience

·       Strong knowledge of claims, formulary, rebates

·       Experience with HIPAA, CMS, healthcare data

·       Track record delivering enterprise products

Preferred Qualifications

·       Medicare Part D, Medicaid, or commercial PBM experience

·       FHIR/HL7 or interoperability experience

·       Specialty pharmacy or value-based care exposure

·       Pricing models (MAC lists, rebates)

Key Competencies

·       Strategic and analytical thinker

·       Strong communication and stakeholder management

·       Data-driven decision making

·       Cross-functional leadership

·       Execution and problem-solvingKind