Operations Lead - Government Pharmacy Benefit Management

Job Description

RxSense is seeking an Operations Lead to build and manage their PBM operational infrastructure, focusing on government healthcare programs. The Operations Lead will establish scalable, efficient operational foundations while ensuring seamless integration of compliance and clinical requirements across all service delivery channels. RxSense is an equal opportunity employer that values diversity.Role involves:

• Designing and implementing PBM operational infrastructure
• Overseeing prescription drug claims processing systems
• Serving as a cross-functional leader to prioritize development needs
• Developing Medicare Part D operational processes
• Establishing Medicaid program operations
• Implementing ACA marketplace PBM operations
• Developing and monitoring key performance indicators (KPIs)

Requirements:

• Bachelor's degree in Business Administration, Healthcare Administration, or related field
• 10+ years of progressive PBM operations experience, with 5+ years in leadership roles
• 8+ years of experience managing government healthcare program operations (Medicare, Medicaid, or ACA)
• Proven track record of building operational infrastructure from the ground up
• Deep understanding of PBM transaction processing systems and claims adjudication
• Comprehensive knowledge of Medicare Part D regulations and CMS requirements
• Proven ability to lead cross-functional teams and complex projects

Role offers:

• Opportunity to work for a leading healthcare technology company
• Chance to build and manage PBM operational infrastructure
• Remote work environment