Senior IT Specialty Analyst
Sentara Health
Manager, Pharmacy Operations
Gravie
full-time
Posted on:
Origin: • 🇺🇸 United States
Visit company websiteSalary
💰 $112,500 - $187,500 per year
Job Level
Mid-LevelSenior
About the role
- Review paid and rejected pharmacy claims daily to identify eligibility issues, benefit setup errors, or potential fraud, waste, and abuse (FW&A)
- Monitor PBM FW&A reporting and coordinate findings with internal stakeholders for resolution or escalation
- Track and support the PBM audit program, including documentation management and audit follow-ups
- Manage day-to-day activities related to pharmacy vendor oversight, including billing reconciliation and performance guarantee tracking for pharmacy vendors
- Oversee pharmacy benefit and formulary configuration, testing, and validation of related reporting and output accuracy
- Collaborate with the Marketing team to ensure member communications reflect timely and accurate pharmacy benefit and formulary updates
- Perform quality reviews of Utilization Management (UM) and Prior Authorization (PA) cases and review reports to understand impacts to Gravie and our members
- Support internal stakeholders such as GravieCare, Sales, and Account Management by helping to troubleshoot and respond to pharmacy benefit inquiries
- Work closely with the Director to continuously improve PBM processes, tools, and reporting
- Demonstrate commitment to Gravie’s core values: being authentic, curious, creative, empathetic, and outcome-oriented
Requirements
- 5+ years of experience in PBM operations, pharmacy claims, or health plan pharmacy departments
- 2+ years of experience in vendor management, claim auditing, or pharmacy benefits analysis
- Familiarity with Medical Pharmacy claims (J-Codes, S-Codes, C-Codes) and formulary management
- Strong analytical skills with a data-driven approach to solving operational problems
- Excellent communication and collaboration skills across technical and non-technical teams
- Proven ability to prioritize and manage multiple projects simultaneously
- Extra credit: Previous work experience in a startup or high-growth company
