Remote Pharmacy Programs Lead - PBM & Medicare Ops

HCSC Group; Nashville (TN); Hybrid; USD 93,000 - 168,000; Full time

Job summary

Health Care Service Corporation is seeking a Pharmacy Programs Manager to provide comprehensive oversight of pharmacy networks and manage day-to-day PBM operations. This remote role supports Medicare plans across the nation, requiring strong project management, communication skills, and attention to pricing accuracy.

The position emphasizes compliance with Medicare/Medicaid regulations and collaboration with PBMs, mail order, and customer service teams to ensure high-quality service.

Qualifications

• Experience with pharmacy networks and/or health plans.
• Project management experience.
• Strong verbal and written communication skills.
• Flexible and able to perform under pressure.
• Proficient in Word, Excel, and database tools.

Responsibilities

• Provide comprehensive pharmacy network oversight and manage day-to-day operations with external PBMs.
• Monitor network pricing setup accuracy and maintain strict operational quality standards.
• Drive PBM vendor performance and oversee mail order and customer service functions.
• Ensure compliance with Medicare, Medicaid, and enterprise regulatory standards.

Skills

Pharmacy networks

Health plan experience

Project management

Verbal and written communication

Under pressure

PC proficiency (Word, Excel, databases

Job description

Health Care Service Corporation is seeking a Pharmacy Programs Manager to provide comprehensive oversight of pharmacy networks and manage day-to-day PBM operations. This remote role supports Medicare plans across the nation, requiring strong project management, communication skills, and attention to pricing accuracy.

The position emphasizes compliance with Medicare/Medicaid regulations and collaboration with PBMs, mail order, and customer service teams to ensure high-quality service.