AffirmedRx, a Public Benefit Corporation

Compliance

• Monitor and interpret federal, state, and local regulations affecting the PBM industry
• Analyze regulatory changes and assess their impact on the organization
• Communicate regulatory updates to relevant stakeholders and provide guidance on implementation
• Conduct regular audits of compliance programs to ensure adherence to internal policies and regulatory requirements
• Prepare detailed reports on audit findings and recommend corrective actions
• Collaborate with internal departments to address compliance issues and implement corrective measures
• Assist in the development and maintenance of compliance policies and procedures
• Ensure that policies are up-to-date and in line with current regulations
• Provide training and support to staff on compliance policies and procedures
• Identify potential compliance risks and develop strategies to mitigate them
• Conduct risk assessments and monitor the effectiveness of compliance controls
• Work with management to implement risk management strategies and ensure ongoing compliance
• Maintain effective communication with regulatory agencies, external auditors, and other stakeholders
• Collaborate with legal, finance, and operational departments to ensure compliance across the organization
• Participate in cross-functional teams to address compliance-related issues and initiatives

Compliance Analyst

Client Partner

• Develop and implement program strategies to optimize outcomes, enhance client experience, and improve overall plan performance
• Collaborate cross-functionally with internal stakeholders, including implementations, analytics, and account management teams, to align initiatives with client needs and objectives
• Serve as the primary point of contact for clients regarding program performance, outcomes, and strategic recommendations, fostering strong client relationships and trust
• Analyze data and trends to identify opportunities for program enhancement, cost savings, and quality improvement, leveraging insights to drive informed decision-making
• Stay informed on industry trends, regulatory changes, and best practices in program management, incorporating relevant insights into program design and implementation
• Develop and deliver client presentations, reports, and updates on program performance, demonstrating value and ROI to key stakeholders
• Collaborate with clients to tailor programs and initiatives to meet their unique needs, ensuring alignment with organizational objectives and priorities
• Foster a culture of continuous improvement and excellence within the team, promoting professional development, knowledge sharing, and accountability for achieving program objectives
• Participate in client webinars, training sessions, and other educational forums, with occasional travel to client events as needed
• Provide ongoing support, including interpreting plan design, resolving phone, written, and electronic inquiries, and addressing benefit and enrollment issues
• Establish and maintain relationships with key client decision-makers, understand their goals, and determine how the organization can best help them achieve results
• Manage and execute client contractual requirements and guarantees
• Retain and grow client relationships
• Maintain an understanding of industry trends and provide clients with insights and recommendations
• Meet with clients to discuss trends, review relevant data, and offer recommendations with supporting rationale for strategies
• Lead client discussions on industry trends, review performance data, and provide recommendations to support plan management strategies
• Develop client relationship and strategy plans
• Monitor key performance indicators and facilitate timely interventions
• Analyze and evaluate reporting, and create ad-hoc reports as requested
• Partner with client team members and internal support teams to deliver best-in-class client service
• Support implementation of new clients, plan changes, and other setup requirements, including gathering requirements, building/coding, quality review, and testing
• Collaborate with the Implementation team during client onboarding to ensure a seamless transition from implementation to client management
• Identify and contribute to process improvement initiatives within the team
• Provide guidance on internal and external collaborative projects and priorities

Strategic Client Success Partner

Vice President

• Oversee teams creating and maintaining comprehensive formularies ensuring alignment with organizational goals and regulatory requirements
• Ensure highest level of cross-functional collaboration to implement formulary changes seamlessly
• Guide specialty pharmacy strategy, including pipeline forecasting, biosimilar adoption, and high-cost drug management
• Provide thought leadership and expertise across Clinical regulatory compliance requirements in support of URAC and Quality Management initiatives
• Remain abreast of industry trends, emerging therapies
• Oversee development of drug coverage policies, prior authorization criteria, and utilization management protocols
• Lead teams that manage the Pharmacy and Therapeutics committee meetings
• Ensure materials created for Pharmacy and Therapeutics committee meetings are aligned with clinical guidelines and membership needs
• Collaborate extensively with cross-functional teams to implement and monitor prior authorization protocols effectively
• Support new Business Development activity, interfacing with current and prospective clients, providing clinical expertise and guidance
• Lead initiatives to improve member outcomes and reduce total cost of care through innovative pharmacy programs
• Build, lead, and inspire clinical teams comprised of Prior Authorizations, Clinical Operations, Formulary Strategies, and Medication Therapy Management fostering a collaborative and dynamic culture
• Ensure accuracy and efficiency in formulary input and maintenance within the management system, holding the team to high standards of performance and precision
• Utilize deep industry knowledge to influence and guide the strategic direction of formulary management, utilization management, and related initiatives
• Manage strategic clinical relationships with key partners in the Pharmacy Benefits Management industry inclusive of vendor relationships and rebate aggregators
• Leverage your experience in Managed Care, PBM or Clinical Pharmacy to navigate industry challenges, drive innovation, and shape the organization’s approach to formulary strategy
• Provide Executive level Clinical expertise and client support to new business development opportunities in collaboration with the AffirmedRx Sales team inclusive of finalist meetings and contracting requirements

Vice President, Pharmacy Clinical & Specialty Strategies

Growth Marketing

• Manage the full sales cycle from lead generation to RFP submission, finalist presentations, negotiations, and contract execution
• Leverage Salesforce.com to track and report sales activities, ensuring transparency and alignment with company growth objectives
• Identify and pursue new business opportunities through coalitions, regional brokers, consultants, and direct client relationships
• Proactively anticipate customer needs and identify opportunities to position AffirmedRx as the best PBM solution
• Strengthen existing broker and consultant relationships, enhancing brand awareness and increasing sales opportunities
• Develop a deep understanding of AffirmedRx’s capabilities to educate and engage potential clients effectively
• Deliver compelling sales presentations that clearly communicate the value of AffirmedRx’s PBM solutions
• Assist in negotiating client contracts to secure favorable terms aligned with company policies and objectives
• Work closely with marketing, operations, proposals, underwriting, implementation, and client management teams to align sales efforts with broader business goals
• Adapt and contribute to a dynamic environment as AffirmedRx continues to grow and expand nationally
• Ability to transfer warm leads to client relationships in collaboration with other team members
• Ability to help onboard and train new sales team members

Director, Strategic Growth

Attorney

• Draft, review, and negotiate contracts, including vendor agreements, service contracts, NDAs, and other legal documents
• Provide legal advice and guidance to internal stakeholders on contractual matters and risk mitigation
• Ensure compliance with applicable laws, regulations, and company policies
• Manage contract lifecycle processes, including renewals, amendments, and terminations
• Partner with Compliance and Privacy
• Collaborate with cross-functional teams, including Growth, Operations, and Finance, to address legal and business needs
• Conduct legal research and stay updated on relevant laws and industry trends
• Assist in resolving contract disputes and provide support in litigation matters, if necessary
• Provide guidance on key regulatory topics, including Consolidated Appropriations Act (CAA) and Employee Retirement Income Security Act (ERISA)

Attorney, Contracts and Regulatory Operations

• Manage the full sales cycle from lead generation to RFP submission, finalist presentations, negotiations, and contract execution
• Leverage Salesforce.com to track and report sales activities, ensuring transparency and alignment with company growth objectives
• Identify and pursue new business opportunities through regional brokers, consultants, and direct client relationships
• Proactively anticipate customer needs and identify opportunities to position AffirmedRx as the best PBM solution
• Strengthen existing broker and consultant relationships, enhancing brand awareness and increasing sales opportunities
• Develop a deep understanding of AffirmedRx’s capabilities to educate and engage potential clients effectively
• Deliver compelling sales presentations that clearly communicate the value of AffirmedRx’s PBM solutions
• Assist in negotiating client contracts to secure favorable terms aligned with company policies and objectives
• Work closely with marketing, operations, proposals, underwriting, implementation, and client management teams to align sales efforts with broader business goals
• Adapt and contribute to a dynamic environment as AffirmedRx continues to grow and expand nationally

Vice President, Strategic Growth

Strategic Growth Executive

Chief Technology Officer

• Provide executive leadership in information strategy, infrastructure, and organizational growth to advance the company’s mission
• Lead the enterprise data and analytics strategy, leveraging AI and advanced tools to improve efficiency, cost savings, and decision-making
• Oversee development of scalable data platforms to deliver actionable business intelligence and client insights
• Drive evaluation and adoption of information solutions that optimize PBM processes and reporting
• Partner with operations to enhance reporting capabilities for clients and internal stakeholders
• Ensure compliance with HIPAA, SOC2, and healthcare regulatory requirements across information and data systems
• Establish and maintain a robust cybersecurity framework to safeguard sensitive information
• Oversee enterprise IT infrastructure, cloud environments, internal systems, and end-user support
• Optimize vendor management and oversee enterprise system integrations
• Implement data governance policies to ensure accuracy, integrity, and regulatory compliance
• Build and develop high-performing information management teams and align investments with business priorities
• Partner with the CFO and advise CEO, Board, and investors on information strategy, risk, and innovation

Chief Information Officer

Business Analyst

• Produce clear, accurate, and timely reporting that supports external client deliverables and internal performance tracking
• Partner closely with the Data & Analytics team to transform raw data into actionable insights
• Tailor outputs for strategic client discussions and provide narrative insights to explain drivers of cost, utilization, and savings
• Develop and deliver standard and ad hoc client reports (e.g., utilization summaries, rebate tracking, trend analysis)
• Consolidate outputs across multiple data sources (claims, clinical, financial) into cohesive, client-ready packages
• Track and report on contractual performance guarantees and ensure accurate measurement and timely reporting to clients
• Monitor internal KPIs (service levels, turnaround times, call handling metrics) and partner with leadership to identify areas of risk or opportunity
• Serve as a bridge between Client Management and Data & Analytics to validate data, define requirements, and troubleshoot issues
• Maintain a reporting library, standard templates, and documentation to ensure consistency and repeatability
• Develop tools or processes to streamline reporting production and minimize manual effort

Client Insights Analyst

Bilingual

• Serve as a liaison between patients and healthcare providers, ensuring members receive high-level care and support
• Advocate for patients' needs, provide education and guidance, and assist with navigating the healthcare system and pharmacy benefits
• Maintain knowledge and proficiency in pharmacy and medical benefit structures across payer types including Medicare, Medicaid, and commercial
• Be proficient in prior authorization and appeals processes for prescription medications
• Remain current with copay assistance eligibility and PBM regulations, policies, and industry trends
• Serve as direct member and provider contact for pharmacy benefit information and navigation support via telephone, chat, fax, email, or written correspondence
• Handle calls and correspondence from providers and members and resolve issues through follow-through and problem resolution
• Educate members and patients about coverage, benefits, and financial assistance programs and assist enrolling into third-party assistance when applicable
• Collaborate with internal and external stakeholders including members, providers, and pharmacies and leverage community-based resources
• Review claims for accuracy against benefit guidelines and contract standards and complete test claims or electronic verification when applicable
• Document all interactions professionally within specified timeframes and assist in meeting operating and productivity standards, including quality reviews

Patient Care Advocate, English/Spanish Bilingual

Analytics Engineer

• The ETL Developer is responsible for designing, developing, and maintaining healthcare data exchange solutions with providers, payers, PBMs, and other trading partners
• Work extensively with ANSI X12 and HIPAA-compliant transaction sets to support claims, eligibility, pharmacy, billing, and enrollment processes
• Partner with source systems, data stewards, and technical teams to ensure effective data governance and resolve data quality or technical issues
• Work closely with business teams (claims, eligibility, pharmacy, billing, enrollment, etc.) to gather requirements and implement data exchange solutions that meet operational needs
• Provide mentorship and technical guidance to junior analysts and engineers
• Design, develop, and maintain data exchange transactions, including maps and workflows, with healthcare providers, payers, PBMs, and other trading partners
• Collaborate with PBM partners to optimize prescription, formulary, and claims workflows
• Ensure compliance with HIPAA, CMS, and other healthcare regulations
• Monitor and improve data exchange performance, reliability, and error-handling processes
• Troubleshoot and resolve issues related to data exchange transactions, connectivity, and partner communications
• Support the development of Master Data Management (MDM) plans, including defining processes, policies, requirements, monitoring, and tool selection
• Monitor MDM services to ensure performance, correct errors, and identify areas for improvement
• Collaborate with data remediators, database administrators, network administrators, and software engineers to resolve issues and document data integration processes and system configurations

ETL Developer

Director

• Oversee the design, implementation, and maintenance of data infrastructure including data lakes, warehouse(s), and pipelines
• Ensure data quality, integrity, and compliance with internal and external standards including HIPAA compliance and other healthcare regulations
• Lead data governance initiatives and establish data management best practices
• Develop and execute a comprehensive analytics strategy aligned with business goals
• Lead the development of predictive models, dashboards, and reporting tools
• Translate complex data into actionable insights for executive leadership and business units
• Build and manage a high-performing team of data engineers, analysts, BI developers and future data scientists
• Foster a culture of innovation, collaboration, and continuous improvement
• Provide mentorship and career development opportunities
• Manage cross-functional analytics projects and ensure timely delivery of data solutions
• Partner with IT, Finance, Marketing, Operations, and other departments to identify data needs and deliver solutions
• Support strategic initiatives with data-driven recommendations and performance metrics
• Present findings and recommendations to senior leadership and influence strategic decisions
• Support external reporting requirements and payer/provider partnerships
• Travel 20%-30% as required

Director, Data Services and Reporting Analytics

• Develop and implement clinical program strategies to optimize patient care outcomes, medication adherence, and overall member experience and plan performance
• Collaborate cross-functionally with internal stakeholders, including pharmacy, implementations, analytics, and account management teams, to align clinical initiatives with client needs and objectives
• Serve as the primary point of contact for clients regarding clinical program performance, outcomes, and strategic recommendations, fostering strong client relationships and trust
• Analyze data and trends to identify opportunities for program enhancement, cost savings, and quality improvement, leveraging insights to drive informed decision-making and innovation
• Remain informed on industry trends, regulatory changes, and best practices in clinical program management, incorporating relevant insights into program design and implementation
• Develop and deliver client presentations, reports, and updates on clinical program performance, demonstrating value proposition and ROI to key stakeholders
• Collaborate with clients to tailor clinical programs and initiatives to meet the unique needs of their member populations, ensuring alignment with organizational objectives and priorities
• Foster a culture of continuous improvement and excellence within the patient care advocate team, promoting professional development, knowledge sharing, and accountability for achieving program objectives
• Participate in client webinars, training sessions, and other educational forums, with occasional travel to client open enrollment events or benefit fairs as needed
• Provide ongoing support which may include, but not limited to, interpreting plan design, research and resolving phone calls, written and electronic inquiries, resolving claims, benefit, and enrollment issues
• Establish and develop relationships with key client decision-makers, understand their healthcare strategy and goals, determine how AffirmedRx can best help them achieve their desired results
• Manage and execute client contractual requirements and guarantees
• Retain clients
• Communicate drug information to clients and respond to plan-specific clinical inquiries; support resolution of member-specific inquiries

Client Manager, PharmD

Operations

• Serve as the primary point of contact for day-to-day operational inquiries from clients and internal teams
• Oversee benefit design setup, annual updates, testing, and processing of change requests
• Partner with internal teams to resolve member-specific issues, including prior authorization (PA) denials, pharmacy processing errors, and eligibility concerns
• Coordinate member communications, ensuring timely approvals and accurate delivery of materials
• Maintain organized client materials, including benefit summaries, plan documentation, and project trackers
• Track, document, and report on the status of client requirements and operational timelines
• Coordinate accordingly to ensure internal and external data needs are met, timely and accurately
• Partner with internal teams (e.g., Implementation, Clinical, Operations) to ensure accurate execution of client requirements
• Support onboarding processes for new client implementations, annual benefit design changes, and benefit updates as needed
• Participate in internal meetings and projects to support client performance and continuous process improvement
• Address system configuration issues, vendor coordination, and shared NPI reporting
• Monitor accumulators and ensure compliance with PA turnaround times and other regulatory metrics
• Escalate complex issues and collaborate with leadership to ensure resolution aligns with client expectations

Client Operations Manager

Content Writer

• Take ownership of assigned proposal tasks, managing day-to-day activities to deliver high-quality work
• Establish and manage project timelines, ensuring timely completion of tasks and adherence to deadlines
• Work within a proposal collaboration tool to organize and populate content effectively
• Support supplemental projects and administrative tasks related to proposal development
• Write, edit, and refine proposal content to ensure clarity, relevance, and alignment with client needs
• Research prospects to tailor content to their industry, challenges, and culture
• Format and finalize proposals to reflect AffirmedRx’s brand and professional standards
• Review and copyedit materials developed by peers and colleagues to maintain consistency and quality
• Collaborate closely with proposal team members, Sales, Pricing, and Subject Matter Experts (SMEs)
• Partner with internal teams to create visually compelling graphical representations of written material
• Participate in database updates to maintain accurate and current proposal content
• Identify opportunities for continuous improvement in proposal development processes
• Ensure consistency, accuracy, and compliance with proposal guidelines and best practices
• Maintain a proactive approach to refining workflows for efficiency and effectiveness
• Ensure all deliverables meet AffirmedRx’s high standards for content and presentation