Senior Pharmacy Benefits Manager

Job not on LinkedIn

🔥 12 hours ago

🇺🇸 United States – Remote

💵 $110.5k - $173k / year

⏰ Full Time

🟠 Senior

💊 Pharmacist

👻 Ghost score 0%

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Devoted Health

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 2017

🏥 Healthcare

⚕️ Healthcare Insurance

🧘 Wellness

Healthcare • Healthcare Insurance • Wellness

Devoted Health is a healthcare company that offers Medicare Advantage plans designed to provide comprehensive health coverage with added benefits like dental, eyewear, gym memberships, and prescription drugs at competitive rates. The company emphasizes member support and service, ensuring that clients can easily navigate their benefits and access needed healthcare services. Devoted Health is committed to helping customers save money and enhance their health and wellness through a complete package of benefits and support.

📋 Description

• Own pharmacy trend for the commercial book of business • Own the PBM relationship and underlying contract • Decompose pharmacy trend into unit cost, utilization, traditional, and specialty drivers • Build and reconcile a savings-initiative pipeline with Finance • Lead PBM procurement and RFPs; negotiate and renegotiate contract terms • Track guarantees, manage independent claims and rebate/pass-through audits, conduct market checks, and recover variances • Evaluate emerging PBM and contracting models and make build-vs-switch recommendations • Develop and monitor pharmacy trend KPIs • Analyze claims data and BI tools to identify spikes, high-cost claimants, and leakage • Run PBM implementations, formulary changes, plan-design rollouts, and audits • Maintain implementation plans, milestones, dependencies, owners, deadlines, and status reporting • Coordinate PBMs, vendors, communications, and operational readiness for go-lives • Assess post-go-live results, savings, and corrective actions • Oversee formulary and utilization-management strategy, including prior authorization, step therapy, and quantity limits • Own specialty and high-cost-claimant strategy, including site-of-care, channel, carve-in/carve-out, stop-loss, and risk-sharing decisions • Drive preferred-product strategy and adoption • Coordinate with Finance, Legal, Compliance, Clinical, Data, medical plan vendors, and client HR/Total Rewards • Translate pharmacy economics into recommendations for senior leadership, fiduciary committees, and clients • Oversee pharmacy member experience, appeals, escalations, coverage communications, and open-enrollment materials • Establish and run ERISA fiduciary oversight processes, including committee support, benchmarking, RFPs, audits, and documentation • Report to the AVP, Pharmacy

🎯 Requirements

• 5-8+ years in pharmacy benefits, PBM operations/account management, payer/managed care pharmacy, or benefits consulting, with demonstrable ownership of PBM contracting and drug-trend outcomes • Deep, current command of PBM economics: pricing/discount guarantees, rebates, spread, formulary and UM levers, and specialty drug management • Proven trend management track record • Fluency with claims data, financial modeling, and BI tools • Rigorous project/program management of complex, multi-stakeholder initiatives • Working knowledge of ERISA fiduciary obligations and CAA/RxDC transparency requirements • Ability to provide current, specific, and honest status reporting • Outstanding communication skills • PharmD or RPh strongly preferred • Master's degree (MBA, MPH, MS) or actuarial/financial background desired • Experience at a benefits consultancy pharmacy practice or on the PBM/payer side, including client-facing account management • Self-insured/plan-sponsor experience • Experience using LLMs to build prompts and lightweight tooling is a plus

🏖️ Benefits

• Employer sponsored health, dental and vision plan with low or no premium • Generous paid time off • $100 monthly mobile or internet stipend • Stock options for all employees • Bonus eligibility for all roles excluding Director and above • Parental leave program • 401K program