Pharmacy Benefits Senior Manager
Core
Own pharmacy trend for commercial book of business, manage PBM relationships and contracts, decompose cost drivers, build savings pipelines, and execute pharmacy implementations.
Role type
Senior IC pharmacy benefits manager (PBM operations & trend analytics)
Builds
Pharmacy savings initiatives, PBM contracts, formulary strategies, and implementation projects
Domain
Health insurance / Pharmacy benefits management
Deliverable
production ML models | product features | dashboards & analysis | client delivery
Required skills
PBM economics (pricing, rebates, guarantees), pharmacy trend decomposition (unit cost/utilization), claims data analysis, financial modeling, project management, ERISA fiduciary oversight, formulary strategy, utilization management
Preferred skills
PharmD or RPh, MBA/MPH, actuarial/financial background, self-insured plan-sponsor experience, AI/LLM tooling
Technologies
Claims data warehouses, BI tools, financial modeling software
Responsibilities
Lead PBM procurement and contract negotiations; manage savings initiative pipeline and reconcile projected vs. realized savings; decompose pharmacy trend into cost and utilization drivers; execute formulary changes and PBM transitions; oversee clinical policy and high-cost claimant strategy; coordinate cross-functional teams for benefit design rollouts
Seniority
Senior, hands-on IC