Business Change Director – CarelonRx PBM Operations Management

Role Overview

• Serves as the primary Medicare pharmacy benefit SME, partnering with health plan product, clinical, and PBM/vendor teams
• Leads end-to-end benefit build lifecycle including documentation, CMS submission support, configuration logic, testing, validation, and promotion to production
• Identifies potential issues, impacts to adjudication logic, and scope changes
• Leads efforts to identify and implement best practices related to Medicare pharmacy benefit design
• Develops and designs processes and systems for accurate benefit setup
• Designs methods for integrating benefit configuration processes across systems
• Provides process, project, and change management methodology coaching/consulting support
• Leads prioritization and execution of benefit-related initiatives tied to CMS deadlines

Requirements

• Requires a BA/BS in a related field
• minimum of 10 years managing mid to large-scale change/project initiatives
• Deep expertise in Medicare Part D pharmacy benefits including benefit design, formulary strategy, and CMS regulatory requirements
• Strong knowledge of Pharmacy Benefit Manager (PBM) operations, including vendor partnership
• Demonstrated experience supporting CMS audits and ensuring compliance
• Proven ability to interpret complex health plan benefit requirements
• Strong cross-functional leadership experience
• Exceptional strategic thinking, attention to detail, and communication skills

Benefits

• merit increases
• paid holidays
• Paid Time Off
• incentive bonus programs (unless covered by a collective bargaining agreement)
• medical
• dental
• vision
• short and long term disability benefits
• 401(k) +match
• stock purchase plan
• life insurance
• wellness programs
• financial education resources