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Title
Text copied to clipboard!Pharmacy Benefit Manager
Description
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We are looking for a Pharmacy Benefit Manager to oversee and optimize the administration of prescription drug programs for health plans, employers, and other healthcare payers. This role is critical in ensuring cost-effective and clinically appropriate medication use while maintaining high levels of service and compliance with regulatory standards.
As a Pharmacy Benefit Manager (PBM), you will be responsible for managing relationships with pharmacies, pharmaceutical manufacturers, and healthcare providers. You will analyze drug utilization data, negotiate pricing and rebates, and implement formulary strategies that balance cost control with patient care. Your work will directly impact the affordability and accessibility of medications for millions of patients.
The ideal candidate will have a strong background in pharmacy, healthcare administration, or a related field, with experience in managed care or pharmacy benefit management. You should possess excellent analytical skills, a deep understanding of pharmaceutical pricing and reimbursement models, and the ability to collaborate with cross-functional teams including clinical, legal, and financial departments.
In this role, you will also be expected to stay current with industry trends, regulatory changes, and emerging therapies. You will play a key role in developing and maintaining drug formularies, managing prior authorization processes, and ensuring compliance with federal and state regulations.
This is a strategic and operational role that requires a balance of clinical knowledge, business acumen, and strong communication skills. If you are passionate about improving healthcare outcomes and reducing costs through effective pharmacy benefit management, we encourage you to apply.
Responsibilities
Text copied to clipboard!- Develop and manage drug formularies and utilization management programs
- Negotiate contracts and rebates with pharmaceutical manufacturers
- Analyze drug utilization and cost data to identify trends and opportunities
- Ensure compliance with federal and state pharmacy regulations
- Collaborate with healthcare providers and pharmacies to optimize patient care
- Oversee prior authorization and appeals processes
- Monitor and report on key performance indicators and outcomes
- Support clinical decision-making with evidence-based guidelines
- Implement cost-containment strategies without compromising care quality
- Coordinate with internal teams including finance, legal, and clinical departments
Requirements
Text copied to clipboard!- Bachelor’s or Doctorate degree in Pharmacy or related field
- 3+ years of experience in pharmacy benefit management or managed care
- Strong knowledge of pharmaceutical pricing and reimbursement models
- Excellent analytical and problem-solving skills
- Familiarity with healthcare regulations and compliance standards
- Effective communication and negotiation skills
- Proficiency in data analysis tools and pharmacy benefit software
- Ability to work collaboratively in cross-functional teams
- Detail-oriented with strong organizational skills
- Licensed pharmacist preferred but not required
Potential interview questions
Text copied to clipboard!- Do you have experience managing drug formularies?
- Can you describe your experience with pharmaceutical contract negotiations?
- How do you stay updated on changes in pharmacy regulations?
- What strategies have you used to reduce drug costs?
- Have you worked with prior authorization processes before?
- What data analysis tools are you proficient in?
- Are you a licensed pharmacist?
- How do you balance cost control with patient care?
- Describe a time you improved a pharmacy benefit program.
- What is your experience with rebate management?
