Program Manager Pharmacy Operations & Formulary/Rebate Management

Program Manager Pharmacy Operations & Formulary/Rebate Management

Location: Mountlake Terrace, WA (Hybrid)
Duration: Contract
Industry: Health Insurance

< class="" data-start="288" data-end="315">Job Description:

We are seeking an experienced Program Manager to oversee pharmacy operations, formulary management, and rebate processing for our client, a mid-sized health insurance company. The ideal candidate will have a deep understanding of pharmacy benefits, PBM relationships, formulary structures, and regulatory compliance while leveraging strong program and project management skills.

< class="" data-start="710" data-end="738">Responsibilities:

• Manage multiple projects related to pharmacy operations, formulary development, and rebate strategy.

• Collaborate with PBMs and internal teams to optimize formulary structures and rebate agreements.

• Ensure adherence to CMS guidelines, healthcare mandates, and regulatory requirements.

• Work with cross-functional teams, including Finance, Compliance, Legal, IT, and Clinical Operations.

• Identify risks, develop mitigation strategies, and drive resolution of operational challenges.

• Monitor program performance and provide data-driven insights on rebates, formulary effectiveness, and compliance.

• Identify and implement process improvements, automation, and best practices.

< class="" data-start="1463" data-end="1498">Required Qualifications:

• 5 years of Program or Project Management experience in pharmacy operations, formulary management, and rebate processing.

• Strong knowledge of health insurance, PBM relationships, and pharmaceutical rebate structures.

• Experience with CMS guidelines, state/federal healthcare mandates, and regulatory frameworks.

• Proven ability to lead cross-functional teams and manage stakeholder relationships.

• Proficiency in Agile, Waterfall, or Hybrid project management methodologies.

< class="" data-start="2016" data-end="2052">Preferred Qualifications:

• Experience in claims processing, utilization management, and benefit design.

• PMP, PgMP, or relevant Project Management certifications.

• Background in healthcare IT systems, pharmacy data analytics, or financial modeling.

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