Senior Project Manager II, Pharmacy Value Programs

Position Summary

The Pharmacy Value Programs Senior Project Manager will lead the development, execution, and continuous improvement of innovative pharmacy benefit cost-savings programs across all lines of business, including Commercial, Exchange, Medicare, and Medicaid.

Position Responsibilities

• Collaborate with key stakeholders to develop and maintain new and existing drug cost containment programs for all lines of business (Commercial, Exchange, Medicare, and Medicaid).
• Engage with appropriate stakeholders and cross-functional teams to ensure successful implementation and execution of programs.
• Regularly update and maintain comprehensive implementation plans, workflow guides, trainings, and other documentation.
• Implement quality control processes to ensure program compliance with established standards and guidelines. Conduct and document audits and work with appropriate stakeholders to implement corrective actions as needed.
• Own relationships with and provide oversight of third-party vendors (including pharmacies) to administer programs with emphasis on member experience and cost savings.
• Data Analytics & Reporting: Use reporting tools and partner with our Analytics team to develop and maintain opportunity analyses and ongoing savings performance reporting.
• Commercialization: Support the go-to-market strategy of savings product offerings including pricing, marketing, and implementation. Support RFI and RFP submissions.
• Continuous quality improvement: Evaluate evolving industry and market landscape and analyze prescription claims data to identify opportunities for improving existing products and developing new products. Supports quality improvement programs/projects as required.

Required Qualifications

• Bachelor’s Degree required
• 4+ years of experience applicable to health care cost management, such as in a health plan, PBM, value-based care, or managed care environment; consulting, advising, or tech enablement focused on the preceding areas also considered applicable
• Great time-management and organizational skills to manage multiple active projects simultaneously
• Exceptional written, verbal, and presentation skills
• Experience working with data reporting tools, conducting data analyses, and effectively consuming/interpreting data reports and visualizations

Preferred Qualifications

• Master’s Degree in relevant field (PharmD, MBA, MHA/MHP, etc.)
• Experience with prescription drug channels and payment workflows (pharmacy reimbursement, rebate administration and GPO relations, regulatory requirements, etc.)
• Experience with health insurance or health benefits administration (pharmacy benefits in particular)
• Strong experience in developing, implementing, and using data and workflow management technology solutions (e.g., customer relationship management (CRM), Jira/Salesforce, collaborative Excel workbooks in SharePoint, etc.)
• Experience with programming languages relevant to data analytics, such as SQL or Python
• Proficient in Microsoft Office Suite with emphasis on Microsoft Excel and PowerPoint
• Ability to think strategically and identify inefficiencies, develop long-term solutions, and challenge and improve existing processes through automation and redesign
• Highly detail-oriented and analytical
• Ability to travel occasionally as needed for internal, client, and vendor/partner meetings