Progyny, Inc.

Senior Director, Pharmacy and PBM Operations

Progyny, Inc.

full-time

Posted on:

Location Type: Remote

Location: New York • United States

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Salary

💰 $165,000 - $195,000 per year

Job Level

Senior

About the role

  • 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

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
Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills & Tools
PBM operationsclaims adjudicationnetwork developmentpricinganalyticsreportingrebatescontractingproject managementprocess improvements
Soft Skills
communication skillsanalytical skillsproblem-solving skillschange agentleadershipcollaborationvisionary mindsetadaptabilitymotivationorganizational success
Certifications
Doctor of PharmacyURAC accreditationACHC accreditation