Pharmacy Manager

Title : Pharmacy Operations & Formulary/Rebate Management

Location: Mountlake Terrace​ - Hybrid

Industry: Health Insurance

Target Rate: $70 - $75/hr on w2

About the Role

Our reputed is seeking an experienced Program Manager to support our client, a mid-sized health insurance company, in managing initiatives related to Pharmacy Operations, Formulary Management, and Rebate Processing. This role requires expertise in pharmacy benefits, formulary design, rebate agreements, and regulatory compliance while also leveraging strong program and project management skills. The Program Manager will act as a strategic partner, ensuring initiatives align with compliance requirements, financial goals, and operational efficiency.

Key Responsibilities

• Program & Project Management: Lead and manage multiple projects within pharmacy operations, formulary development, and rebate strategy, ensuring successful execution aligned with client objectives.
• Formulary & Rebate Strategy: Work closely with the client’s internal teams and PBMs (Pharmacy Benefit Managers) to develop, maintain, and optimize formularies and rebate agreements.
• Regulatory & Compliance Oversight: Ensure adherence to federal and state mandates impacting pharmacy benefits, formulary structures, and rebate processes. Provide guidance on policy changes and implementation.
• Stakeholder Engagement: Collaborate with client teams across Finance, Compliance, Legal, IT, and Clinical Operations to drive alignment and facilitate successful program execution.
• Risk & Issue Management: Identify risks early, develop mitigation strategies, and lead resolution efforts for challenges within the client’s pharmacy operations and rebate programs.
• Performance Monitoring & Reporting: Provide data-driven insights on program KPIs, rebate financial impact, and formulary performance, supporting client leadership in strategic decision-making.
• Process Improvement: Identify and recommend best practices, automation opportunities, and workflow enhancements to improve efficiency and compliance within pharmacy operations.

Required Qualifications

• 5 years of experience in Program or Project Management, with a focus on pharmacy operations, formulary management, and rebate processing.
• Strong understanding of health insurance, PBM relationships, and pharmaceutical rebate structures.
• Familiarity with CMS guidelines, state/federal healthcare mandates, and regulatory frameworks affecting pharmacy benefits.
• Experience in leading cross-functional teams and managing relationships with internal and external stakeholders.
• Proficiency in program management methodologies (Agile, Waterfall, Hybrid).
• Ability to navigate complex regulatory and operational landscapes in the health insurance industry.

Preferred Qualifications

• Experience with claims processing, utilization management, and benefit design.
• PMP, PgMP, or relevant certification in Program or Project Management.
• Background in healthcare IT systems, pharmacy data analytics, and financial modeling.