What are the responsibilities and job description for the Director of Operations, PBM position at Virtual?
The Director will ensure the PBM aligns with our strategic goals of improving patient outcomes, optimizing cost management, and enhancing overall service quality.
Key Responsibilities :
- Strategic Leadership : Lead the creation of Pharmacy Benefit Manager, from conceptualization through full operational launch, driving the overall strategy, vision, and execution.
- Vendor Transition Management : Oversee the transition away from existing external PBM vendors (e.g., Optum) and ensure a seamless and cost-effective shift to in-house management.
- Operational Development : Design and develop core PBM functions, including claims processing, pharmacy network development, formulary development & management, drug utilization review, prior authorization review, P&T coordination, and specialty pharmacy services.
- Financial Oversight : Establish pricing strategies, rebate programs, and pharmacy network contracts to maximize cost savings while maintaining high-quality care.
- Regulatory Compliance : Ensure PBM operations adhere to all regulatory requirements, including state and federal healthcare laws, and oversee all reporting and auditing functions.
- Partnership & Collaboration : Build and maintain strong relationships with internal stakeholders, pharmaceutical companies, and pharmacy networks to ensure the success of the PBM.
- Team Leadership : Recruit, mentor, and manage a high-performing team capable of delivering on the operational and financial goals of the PBM.
- Continuous Improvement : Identify and implement best practices and innovative solutions to improve PBM service delivery, reduce costs, and enhance member satisfaction.
Qualifications :
