Senior Pharmacy Ops Leader — Remote PBM & Medicaid

Mass General Brigham; Somerville (MA); Remote; USD 64,000 - 93,000; Full time

Benefits offered by this job

Remote work eligible

Job summary

Mass General Brigham Health Plan is seeking a Senior Pharmacy Operations Specialist to lead the administration, implementation, and continuous improvement of the pharmacy benefit for Commercial and Medicaid members across lines of business.

The role combines operational expertise, vendor oversight, system implementations, regulatory support, and project leadership within a premier integrated health system. Remote work eligible for US locations.

Qualifications

• Bachelor's Degree required; experience can be considered in lieu of a degree.
• Pharmacy Technician license preferred.
• Pharmacy Technician Certification license preferred.

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 opportunities to improve efficiency, accuracy, and quality.
• Monitor PBM operational performance and hold vendors accountable for timely 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 configurations.
• Support compliance with state, federal, contractual, and regulatory requirements for Commercial and Medicaid products.
• Analyze pharmacy claims and operational data to identify trends and develop leadership-focused reporting.
• Lead cross-functional pharmacy initiatives from requirements through implementation.

Skills

Data analytics

SQL

Excel

Reporting tools

Pharmacy benefits

Education

Bachelor's degree in related field

Tools

PBM systems

Claims adjudication systems

Job description

Mass General Brigham Health Plan is seeking a Senior Pharmacy Operations Specialist to lead the administration, implementation, and continuous improvement of the pharmacy benefit for Commercial and Medicaid members across lines of business.

The role combines operational expertise, vendor oversight, system implementations, regulatory support, and project leadership within a premier integrated health system. Remote work eligible for US locations.