Remote Senior Pharmacy Benefits Operations Manager

Mass General Brigham; United States; Remote; USD 64,000 - 93,000; Full time

Job summary

Mass General Brigham Health Plan is seeking a Senior Pharmacy Operations Specialist to oversee the administration, implementation, and continuous improvement of the pharmacy benefit for Commercial and Medicaid members. You will drive operational excellence and partner with PBMs, vendors, and internal teams to ensure compliant, efficient benefit operations.

The role requires 5–7 years in pharmacy benefit or related work, a Bachelor’s degree, and strong analytics with Excel; remote-friendly;

Qualifications

• Bachelor’s Degree Related Field of Study required; experience can be considered in lieu of a degree
• Pharmacy Technician license preferred
• Pharmacy Technician Certification license preferred
• At least 5-7 years of pharmacy benefit, managed care, PBM, health plan, pharmacy operations, or related healthcare experience required
• At least 3-5 years of experience working with pharmacy claims, benefit configuration, formulary, utilization management, or PBM operations required

Responsibilities

• Ensure effective day-to-day administration of the pharmacy benefit across all lines of business.
• Research and resolve complex operational issues, identify root causes, and implement sustainable corrective solutions.
• Monitor pharmacy operational processes and identify and advance opportunities to improve efficiency, accuracy, and quality.
• Monitor PBM operational performance and hold vendors accountable for timely, accurate deliverables and service standards.
• Coordinate issue resolution, implementations, testing, and ongoing operational activities with the PBM and internal partners.
• Translate benefit and clinical requirements into operational specifications and validate formulary, utilization management, benefit, and claims configurations.
• Support compliance with applicable state, federal, contractual, and regulatory requirements, including audits, regulatory implementations, corrective action plans, and ongoing compliance monitoring for Commercial and Medicaid products.
• Analyze pharmacy claims and operational data to identify trends, anomalies, and opportunities, and develop reporting that supports operational and leadership decision-making.
• Lead cross-functional pharmacy initiatives from requirements through implementation, and serve as a subject matter expert and mentor who promotes consistent processes and operational standards across the Pharmacy Operations team.

Skills

Pharmacy operations

Data analytics

SQL

Communication

Project management

Education

Bachelor’s Degree Related Field of Study

Tools

Excel

Claims systems

Job description

Mass General Brigham Health Plan is seeking a Senior Pharmacy Operations Specialist to oversee the administration, implementation, and continuous improvement of the pharmacy benefit for Commercial and Medicaid members. You will drive operational excellence and partner with PBMs, vendors, and internal teams to ensure compliant, efficient benefit operations.

The role requires 5–7 years in pharmacy benefit or related work, a Bachelor’s degree, and strong analytics with Excel; remote-friendly;