Senior Director, Pharmacy and PBM Operations

Role Overview

• 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