Lead the development of pharmacy products, including service area expansion and submission to CMS, ensuring alignment with regulatory requirements, market needs, and organizational objectives.
Collaborate with internal & external stakeholders including pharmacists, PBMs, developers, compliance teams, and marketing to gather requirements, prioritize features, and ensure successful implementation of pharmacy initiatives.
Collaborate with data analytics teams to conduct prescription benefit market analysis, evaluate competitors offerings per each service area and identify industry trends to generate product enhancements.
Monitor and analyze product performance, including utilization trends, financial impact and member experience, identifying opportunities for improvement.
Support operational readiness for Annual Enrollment Period (AEP) and product launches, including production of the pharmacy-related customized communication and marketing materials.
Perform AEP staff training and cross-functional alignment.
Support RFP process, including evaluation criteria, to optimize pharmacy benefit operations, financial performance, and member experience.
Contribute to the development and maintenance of policies, procedures, and training materials.
Maintain professional and technical knowledge by attending educational workshops; reviewing professional publications; establishing personal networks; participating in professional societies.
Serve as a subject matter expert on pharmacy products and benefits, supporting cross-functional teams during CMS and state regulatory audits, including CMS Part C and D Data Validation audits.
Prepare presentations and updates to leadership regarding product performance, upcoming initiatives, and regulatory changes.
Ensure products meet HIPAA, FDA, CMS, and other pharmacy-related regulatory standards.
Maintain current knowledge of Medicare Part D regulations by participating in CMS calls and reading released guidance and implementing changes to maintain compliance.
Serve as the subject matter expert on the Inflation Reduction Act’s Medicare Part D provisions, CMMI initiatives and Medicare Prescription Payment Plan.
Foster strong relationships with PBM partners to align on product implementation, service delivery, and continuous improvement initiatives.
Participate in the annual BID cycle development process.

Requirements

3–5 years of experience in pharmacy benefits management, managed care pharmacy, or product management within healthcare
Bachelor's Degree or equivalent experience required
PharmD, MBA, Graduate or related advanced degree preferred
Expertise with Medicare Part D and/or Medicaid pharmacy programs
Experience working with PBMs and cross-functional teams in a health plan or pharmacy operations setting
Proven project management experience applying industry methodologies and practices
Ability to manage and adapt to a significant change
Strong leadership skills, including excellent interpersonal, communications, problem-solving and negotiating skills
Strong analytical and problem-solving skills
Strong analytical and critical thinking skills, required
Ability to manage multiple projects simultaneously with strong attention to detail
Knowledge of CMS Part D regulations and pharmacy benefit design
Ability to work cross-functionally and collaboratively across the organization
Ability to think strategically and act tactically
Technologically savvy and able to utilize information systems effectively
MS Office (Word, Excel, PowerPoint, Access), Visio, and SQL
Strong interpersonal skills, including excellent written and verbal communication skills
Strong organizational skills
Ability to appropriately maintain confidentiality.

Benefits

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Applicant Tracking System Keywords

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

Hard Skills & Tools

pharmacy benefits managementmanaged care pharmacyproduct managementproject managementMedicare Part DMedicaid pharmacy programsCMS Part D regulationspharmacy benefit designdata analyticsfinancial analysis

Soft Skills

leadershipinterpersonal skillscommunication skillsproblem-solvingnegotiating skillsanalytical skillscritical thinkingattention to detailstrategic thinkingcollaboration

Certifications

PharmDMBAGraduate degreerelated advanced degree