Senior Project Manager, Pharmacy Value Programs

Capital Rx is an enterprise health technology company providing pharmacy benefit management solutions. The Senior Project Manager will lead the development and execution of innovative pharmacy benefit cost-savings programs, collaborating with internal teams and external partners to enhance member experience and reduce drug spending.

Responsibilities:

• Collaborate with key stakeholders to develop and maintain new and existing drug cost containment programs for all lines of business (Commercial, Exchange, Medicare, and Medicaid). Programs include, but are not limited to, partnerships with innovative mail & specialty pharmacies, benefit design optimization, and integration with manufacturer direct offerings
• Engage with appropriate stakeholders and cross-functional teams to ensure successful implementation and execution of programs
• Regularly update and maintain comprehensive implementation plans, workflow guides, trainings, and other documentation
• Implement quality control processes to ensure program compliance with established standards and guidelines. Conduct and document audits and work with appropriate stakeholders to implement corrective actions as needed
• Own relationships with and provide oversight of third-party vendors (including pharmacies) to administer programs with emphasis on member experience and cost savings
• Use reporting tools and partner with our Analytics team to develop and maintain opportunity analyses and ongoing savings performance reporting
• Support the go-to-market strategy of savings product offerings including pricing, marketing, and implementation. Support RFI and RFP submissions
• Evaluate evolving industry and market landscape and analyze prescription claims data to identify opportunities for improving existing products and developing new products. Supports quality improvement programs/projects as required

Requirements:

• Bachelor's Degree required
• 4+ years of experience applicable to health care cost management, such as in a health plan, PBM, value-based care, or managed care environment; consulting, advising, or tech enablement focused on the preceding areas also considered applicable
• Ability to balance multiple complex projects simultaneously with minimal direction
• Great time-management and organizational skills to manage multiple active projects simultaneously
• Exceptional written, verbal, and presentation skills
• Experience working with data reporting tools, conducting data analyses, and effectively consuming/interpreting data reports and visualizations
• Master's Degree in relevant field (PharmD, MBA, MHA/MHP, etc.)
• Experience with prescription drug channels and payment workflows (pharmacy reimbursement, rebate administration and GPO relations, regulatory requirements, etc.)
• Experience with health insurance or health benefits administration (pharmacy benefits in particular)
• Strong experience in developing, implementing, and using data and workflow management technology solutions (e.g., customer relationship management (CRM), Jira/Salesforce, collaborative Excel workbooks in SharePoint, etc.)
• Experience with programming languages relevant to data analytics, such as SQL or Python
• Proficient in Microsoft Office Suite with emphasis on Microsoft Excel and PowerPoint
• Ability to think strategically and identify inefficiencies, develop long-term solutions, and challenge and improve existing processes through automation and redesign
• Highly detail-oriented and analytical
• Ability to travel occasionally as needed for internal, client, and vendor/partner meetings