Program Manager

The Prism Health Group; United States; On-site; USD 110,000 - 160,000; Full time

Job summary

The Prism Health Group is seeking a Program Manager to lead the development and refinement of PBM-focused processes, playbooks, and tools. You will coordinate with consulting, analytics, and client management teams to deliver repeatable, high-quality outcomes for client partners.

The role requires deep PBM knowledge, project leadership, and a track record of turning complex data into actionable workflows within a fast-moving consulting environment.

Qualifications

• 10+ years of experience in pharmacy benefit management, pharmacy consulting, or related healthcare ops.
• Deep PBM operations knowledge including claims adjudication, plan design, rebates, and utilization management.
• Strong ability to translate complex concepts into practical tools, templates, and scalable processes.

Responsibilities

• Lead cross-functional teams to define and implement scalable PBM operational processes.
• Develop templates, playbooks, dashboards, and trackers to standardize client deliverables.
• Collaborate with consulting operations, client management, analytics, and implementation teams to close process gaps.

Skills

Project management

PBM knowledge

Data analysis

MS Office

Education

Bachelor’s degree

Tools

Excel

PowerPoint

SQL

Job description

Company Description

The Prism Health Group, LLC (Prism) is an independent pharmacy consulting firm that provides a wide array of pharmacy specific consulting and analytics solutions that lowers the cost of care, improve care delivery, and enhances the quality of our client partner’s respective pharmacy programs.

Prism was founded in 2019, on the premise that the healthcare industry lacked an independent and objective voice to those struggling to reign-in their pharmacy program performance. In addition to deploying conventional pharmacy consulting solutions, Prism assists self-funded plan sponsors, health plans, and third-party administrator (TPA) organizations to thoughtfully develop and implement uniquely tailored enterprise pharmacy strategies and solutions. Specifically, Prism’s industry expertise and exposure to multiple national pharmacy delivery models affords a unique perspective for client partners seeking to develop and deploy intrinsically unique enterprise pharmacy solutions.

Opportunity Description

The Program Manager serves as a highly technical, operationally focused subject leader within the Prism enterprise. This position is responsible for helping create, organize, and advance the internal processes, project management standards, product development frameworks, and repeatable operating systems required to help Prism scale efficiently while continuing to deliver highly customized, high-quality pharmacy consulting solutions to client partners.

This role is intended for an individual with deep pharmacy benefit management, pharmacy operations, and consulting delivery experience. The Program Manager must understand the technical, financial, clinical, operational, and data-driven elements of the PBM marketplace, while also having the ability to translate that knowledge into practical tools, templates, workflows, analytics resources, and project management expectations that make Prism’s work more consistent, repeatable, efficient, and innovative.

The individual in this role will work cross-functionally with internal subject matter experts across consulting operations, client management, data analytics, clinical strategy, rebate and financial analytics, implementation, and broader practice administration. This position will be expected to help convert complex intellectual capital into scalable solutions that improve internal execution, reduce duplicative work, enhance client deliverables, and strengthen Prism’s ability to serve clients with greater speed, precision, and consistency.

Given the sensitive nature of Prism’s work, integrity is critical. The Program Manager must maintain the highest standards of confidentiality, demonstrate strong stewardship of client and member information, and bring a high degree of humility, grit, organization, and thoughtful innovation to a fast-moving, entrepreneurial consulting environment.

This position will report to the Managing Director of Practice Administration and may eventually have the opportunity to advance including overseeing direct reports as Prism continues to expand its operational infrastructure and product development capabilities.

• Attest and commit to putting forth humility, authenticity, and dedicated stewardship to client partners, members / patients, internal partners, and external partners;
• Support the development, organization, and implementation of enterprise-wide project management standards, operating expectations, workflow models, and process governance across Prism’s service delivery model;
• Partner with internal subject matter experts to convert technical PBM, pharmacy operations, rebate, claims, plan design, clinical, and implementation knowledge into practical tools, templates, resources, and repeatable solutions;
• Help design and advance internal products, frameworks, and consulting resources that improve the consistency, quality, scalability, and efficiency of Prism’s client deliverables;
• Translate complex PBM financial, clinical, operational, and data-driven concepts into organized project plans, process maps, decision frameworks, client-facing tools, and internally repeatable work products;
• Support development of standardized project plans, timelines, scope expectations, implementation workflows, client deliverable templates, internal trackers, and quality control processes;
• Work closely with consulting operations, client management, data analytics, clinical strategy, rebate analytics, implementation teams, and practice administration to identify process gaps and drive practical solutions;
• Assist in building scalable processes related to PBM market checks, RFP support, implementations, plan design changes, eligibility management, claims adjudication, rebate reporting, clinical program logistics, prior authorization, utilization management, and client reporting;
• Develop and maintain internal resources that help staff produce high-quality outputs more efficiently, including templates, playbooks, dashboards, project trackers, process documents, and structured deliverable frameworks;
• Support ad hoc analytics needs by interpreting pharmacy claims data, eligibility data, rebate reporting, plan design information, PBM financial models, and operational reporting to inform practical business solutions;
• Apply knowledge of pharmacy benefit manager financial models, pricing structures, administrative fees, rebate arrangements, specialty pharmacy economics, network models, and clinical management programs to support internal and client-facing work;
• Help identify opportunities to use artificial intelligence, automation, code-enabled workflows, Microsoft applications, SQL Server, and other technical tools to improve efficiency, reduce manual work, and enhance quality control;
• Serve as a functional bridge between technical SMEs and operational teams by helping organize complex thinking into clear, usable, and scalable internal processes;
• Support internal change management by helping establish clear process expectations, role clarity, accountability structures, and disciplined project execution standards;
• Proactively identify areas where Prism’s consulting work can become more repeatable, more organized, more efficient, and more innovative without compromising the customized nature of client service;
• Support development of internal training materials, reference guides, and process documentation to help team members consistently execute against Prism’s expectations;
• Manage multiple projects and priorities in a fast-paced environment where new information, shifting deadlines, and evolving client needs may arise;
• Demonstrate strong interpersonal and collaborative skills, including the ability to convey technical concepts clearly, solicit feedback, align internal stakeholders, and help drive consensus;
• Uphold company mission and values through demonstrating alignment, authenticity, grit, thoughtful innovation, disciplined execution, and a strong bias toward practical improvement.

Core Competencies & Qualifications

• Bachelor’s degree in business, healthcare administration, pharmacy, data analytics, finance, information systems, or a related field preferred;
• Ten (10) years plus of experience in pharmacy benefit management, pharmacy consulting, pharmacy operations, health plan operations, benefit administration, or a closely related healthcare environment;
• Deep understanding of pharmacy benefit manager operations, including claims adjudication, eligibility, plan design, formulary administration, rebate reporting, specialty pharmacy, network management, clinical program operations, prior authorization, and utilization management;
• Strong working knowledge of PBM financial models, including administrative fees, rebate guarantees, specialty pharmacy economics, spread / pass-through pricing concepts, network discounts, clinical program financials, and pharmacy cost drivers;
• Demonstrated ability to translate complex pharmacy benefit, operational, clinical, financial, and data-driven concepts into clear tools, workflows, templates, and practical business solutions;
• Experience developing or managing project plans, process improvement initiatives, implementation workflows, operating models, product development efforts, or internal business transformation initiatives;
• High proficiency in Microsoft Office applications, including Excel, Word, PowerPoint, Outlook, OneNote, and Teams;
• Experience with pharmacy data environments, data validation, reporting logic, or similar technical platforms preferred;
• Familiarity with artificial intelligence tools, automation concepts, code-enabled workflows, analytics platforms, or emerging technology solutions that can improve operating efficiency preferred;
• Ability to work effectively with internal subject matter experts and convert specialized knowledge into organized, scalable, and repeatable resources;
• Demonstrated use of initiative and innovation to identify process gaps, create solutions, improve workflows, and strengthen organizational efficiency;
• Ability to operate successfully in a fast-growing, entrepreneurial, and sometimes nebulous environment where structure must be built while work is actively moving forward;
• Strong attention to detail, organizational discipline, project management instincts, and ability to manage multiple priorities with limited oversight;
• Excellent written and verbal communication skills, with the ability to create polished internal and client-facing materials;
• Demonstrated ability to interact professionally and communicate effectively with internal staff, external partners, vendors, and client stakeholders;
• Strong cultural alignment with Prism’s values, including independence, stewardship, humility, authenticity, grit, thoughtful innovation, and a commitment to doing high-quality work;
• Ability to travel approximately 10% to 20%, including periodic travel to Prism headquarters, anticipated to be approximately once monthly.