Remote Pharmacy Performance & Operations Lead

GEHA

Missouri

Hybrid

USD 82,000 - 115,000

Full time

12 days ago

Application generator

A complete application in a minute — tailored resume and cover letter, ready to send.

Get past ATS filters

Benefits offered by this job

Health/Vision/Dental benefits

401(k) retirement plan with company-mt

Paid Time Off

Tuition Assistance Program

Hybrid/work-from-home options

Job summary

Government Employees Health Association, Inc. (G.E.H.A) seeks a Sr. Pharmacy Performance & Operations Specialist to oversee FEHB and PSHB pharmacy programs, drive PBM performance, and ensure contractual and regulatory compliance.

The role acts as SME and liaison to the PBM, delivering data-driven insights for strategic decisions. The ideal candidate has 5+ years in PBM/pharmacy operations, strong analytical skills, and experience building dashboards.

Qualifications

Bachelor's degree in healthcare administration, Pharmacy, Business Administration, Public Health, or related field.
A minimum of 5 years of progressive experience in pharmacy operations, PBM, health plan operations, or federal health program administration (FEHB/PSHB).
FEHB/PSHB program knowledge: familiarity with federal requirements and regulatory expectations.
Analytical and reporting skills: proficiency in building dashboards and interpreting performance data.
Contract interpretation: understanding contractual terms and applying them to operations.
Problem-solving abilities: diagnosing issues and developing solutions.
Communication skills: explaining complex PBM concepts clearly.
Attention to detail: accuracy in reviewing claims, reports, and compliance docs.
Cross-functional collaboration: working with internal teams, PBM partners, and regulators.
Executive communication: translating PBM/financial/regulatory concepts into insights.

Responsibilities

Oversee PBM contract performance and ensure alignment with guarantees and federal requirements.
Prepare, validate, and submit annual pharmacy benefit changes for FEHB/PSHB.
Develop division reports, dashboards, and executive presentations to monitor plan performance.
Manage PBM contractual credits, including reporting, validation, and QA processes.
Monitor and enforce PBM contractual obligations and regulatory requirements.
Serve as SME for pharmacy benefits including design and configuration.
Draft and coordinate PBM performance-related letters and actions.
Support contract governance activities and issue escalation.
Monitor call center performance, identify trends, drive solutions for member experience.
Track eligibility changes and population shifts impact on performance.
Identify gaps and develop corrective action plans.
Review pharmacy-related Customer Success content for accuracy.
Respond to audit inquiries with documentation and readiness.
Validate production and pre-production claims accuracy with benefit design terms.
Investigate and resolve complex pharmacy-related member issues and escalations.
Manage day-to-day program operations and new initiatives.
Serve as liaison to PBM for operations, implementation, and eligibility matters.
Coordinate cross-functional efforts to resolve PBM issues and drive performance.