We envision a world where everyone can realize dreams of family and ideal health.

Senior Director, Pharmacy and PBM Operations

OperationsOperationsFull TimeRemoteTeam 201-500Since 2015H1B No SponsorCompany Site LinkedIn

Location

New York

Posted

18 days ago

Salary

$165K - $195K / year

Postgraduate Degree12 yrs expEnglish

Job Description

• Oversee and manage key PBM/pharmacy programs, providing operational leadership at both tactical and strategic levels • Develop, support, and execute end-to-end lifecycle of PBM/pharmacy-related operational projects and deliverables • Serve as the primary contact for PBM/pharmacy trading partners • Implement and enhance operational processes to improve efficiency, accuracy, and customer satisfaction • Collaborate with cross-functional teams for seamless integration of new programs and services • Monitor and analyze key performance indicators to identify areas for improvement and optimization • Act as a thought partner, sounding board, and strategic advisor to Progyny leadership and cross-functional partners • Provide analysis, recommendations, and options regarding high-impact decisions • Support the rebate management process from both trading partner and employer client perspectives

Job Requirements

12+ years of extensive experience in PBM operations, including interaction with self-funded and employer-sponsored health plan benefits
Doctor of Pharmacy preferred
Knowledge of accreditation standards (URAC, ACHC) is a plus
Comprehensive knowledge of PBM/pharmacy/healthcare industry, PBM operations, third party administrators, benefit setup (ASO and fully-insured), pharmacy claims, and managed care
Strong understanding of PBM processes: claims adjudication, network development, pricing, analytics/reporting, rebates, clinical aspects, trade, contracting, systems, and account management
Experience negotiating contracts with PBMs and pharmacies
Visionary mindset with the ability to anticipate and navigate emerging changes in the healthcare landscape and identify innovative solutions to complex challenges
Exceptional communication skills to convey complex PBM/pharmacy concepts to diverse stakeholders, fostering clear understanding and driving organizational success
Proven change agent with the ability to initiate and lead initiatives, motivate teams, and foster a culture of adaptability, high performance, accountability, excellence, and continuous improvement
High proficiency in project management methodologies for effective planning, execution, and monitoring of key initiatives, ensuring timely delivery of results
Strong analytical and problem-solving skills with attention to detail for addressing complex operational challenges
Ability to manage expectations and facilitate understanding at all organizational levels, both internally and externally
Capacity to lead, oversee, prioritize, and handle multiple projects and clients with dynamic and shifting timelines, utilizing proven project management processes
Demonstrated success in driving operational excellence and executing process improvements in a high-growth, fast-paced, entrepreneurial business setting, with a focus on measuring results and achieving targeted outcomes

Benefits

Paid family and parental leave
Preconception, fertility and family building benefits (including egg freezing, IVF, and adoption support)
Family and pet care fund
Parents’ Employee Affiliation Group
Menopause and midlife care
Health, dental, vision and life insurance options for employees and family
Free in-person, virtual and text-based mental health and wellness support
Paid time off, including vacation, sick leave, personal days and summer flex time
Company equity
Bonus program
401(k) plan with company match
Access to on-demand legal and financial advice
Learning and development programs to help you grow professionally and a mentorship program
Company social events to include annual volunteer day and donation matching
Flex days (3 days a week in the office) and onsite meals and snacks for employees reporting into our NY office