PBM Technical Operations Director (REMOTE)

Lensa; Baltimore (MD); Remote; USD 140,000 - 260,000; Full time

Job summary

A leading company in healthcare is seeking a PBM Technical Operations Director to oversee technical support functions and manage a team. This remote role involves directing operations related to Pharmacy Benefit Management, ensuring alignment with strategic objectives and enhancing operational efficiency. Candidates should possess a Bachelor's degree and extensive experience in IT and PBM operations.

Benefits

Comprehensive benefits

Incentives

401k plans

Qualifications

• 8 years in IT and/or PBM operational environment; 3 years in management.
• Excellent communication and problem-solving skills.
• Must meet deadlines and handle multiple demands.

Responsibilities

• Lead daily technical resources supporting PBM Operations.
• Manage performance evaluations, hiring, and coaching staff.
• Collaborate with IT to align business objectives.

Skills

Communication

Problem Solving

Organizational Skills

Prioritization Skills

Customer Service

Education

Bachelor's Degree in Business Administration, IT, or related field

Tools

Microsoft Office

Job description

PBM Technical Operations Director (REMOTE)

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Lensa is the leading career site for job seekers at every stage of their career. Our client, CareFirst BlueCross BlueShield, is seeking professionals. Apply via Lensa today!

Purpose

The Director, PBM Technical Operations provides leadership, oversight, and guidance to technical and operational support functions. They analyze performance and recommend improvements. The role involves directing day-to-day technical support of systems supporting Pharmacy Benefit Management (PBM) programs, including technical design, implementation, deployment, and ongoing support. The Director also provides leadership for the technical enablement of key business functions, including benefit, eligibility, and transaction interfaces with third-party PBMs, ensuring support of the company's strategic objectives.

Essential Functions

1. Lead the daily technical resources supporting PBM Operations, including systems supporting benefits, eligibility, and accumulators. This includes analyzing and resolving enterprise-wide user or customer issues, monitoring system effectiveness, representing CF interests externally, and maintaining critical processing files.
2. Manage performance evaluations, pay reviews, hiring, and termination decisions. Coach and mentor staff to improve performance and support career growth and succession planning.
3. Oversee business analyst and project management functions supporting SDLC, including requirements definition, system specifications, testing, and user procedures. Provide expert system and business knowledge to support complex business issues aligned with CareFirst's strategic goals.
4. Collaborate with IT to ensure alignment between IT and business objectives. Lead interface and collaboration efforts to define, prioritize, and implement projects and change management initiatives.
5. Contribute to the development of strategic and tactical plans for each division, monitor key metrics, resource and budget plans, and improve operating procedures impacting system support.
6. Research industry best practices in PBM operations, transaction adjudication, and data management. Advise peers and management on strategies that enhance CF's functional and expense management capabilities.

Qualifications

• Education: Bachelor's Degree in Business Administration, IT, or related field, or equivalent work experience (additional 4 years).
• Experience: 8 years in IT and/or PBM operational environment; 3 years in management.
• Knowledge, Skills, and Abilities: Excellent communication skills, problem-solving ability, organizational and prioritization skills, proficiency in Microsoft Office, and customer service skills. Must meet deadlines and handle multiple demands. Licenses/Certifications may be required.

Salary Range: $140,000 - $259,875. Compensation depends on experience, education, and location. CareFirst offers comprehensive benefits, incentives, and 401k plans.

Additional Information

This role is part of the 2024-2026 PBM/Pharmacy RFP department. CareFirst is an Equal Opportunity employer. Applicants must be eligible to work in the U.S. without sponsorship. The physical demands include mostly seated work, occasional walking, and lifting up to 25 pounds.