Pharmacy Design Consultant

Key Responsibilities

• Lead the end-to-end creation, validation, loading and maintenance of pharmacy benefit plan designs/IG’s
• Develop and maintain client Implementation Guides, ensuring accuracy, clarity, and alignment with benefit requirements
• Translate complex client benefit requests into actionable system configurations within established capabilities
• Provide guidance to cross-functional teams, including Client Success, Operations, Compliance, and Operations
• Recommend best practices for benefit design to ensure accuracy, efficiency, and consistency across clients
• Provide support and second set of eyes on all new client implementations testing
• Work closely with implementation teams to ensure smooth client onboarding and benefit transitions
• Support internal teams with benefit interpretation questions and technical clarifications
• Stay current on ACA requirements, state regulations, and clinical program capabilities
• Maintain version control and auditability of Implementation Guides

Qualifications

• Minimum of 3-5 years’ experience in pharmacy benefits, PBM operations or healthcare plan configuration
• Proven ability to interpret plan design documents from external carriers
• Knowledge of ACA mandates and state-specific benefit rules
• Strong time management and prioritization skills
• Excellent communication and collaboration skills
• Experience working cross-functionally with implementation or client-facing teams
• Extremely detail-oriented and organized