Senior Pharmacy PBM Performance & Operations Lead

Socket.dev; Lee's Summit (MO); On-site; USD 82,000 - 115,000; Full time

Benefits offered by this job

Health benefits

401(k) plan

Paid time off

Tuition assistance

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.

You will manage PBM performance, ensure contractual compliance, and provide data-driven insights to guide strategic decisions that improve member outcomes. The role requires at least 5 years in PBM/pharmacy operations or federal health program administration, with strong analytical, reporting, and cross-functional collaboration skills.

Qualifications

• Bachelor's degree or higher in healthcare administration, pharmacy, business administration, public health, or related field.
• Minimum 5 years of progressive experience in PBM, pharmacy operations, or federal health programs.

Responsibilities

• Oversee PBM contract performance and ensure alignment with guarantees and federal requirements.
• Prepare and submit annual FEHB and PSHB program changes.
• Develop dashboards and executive-level reports to monitor plan performance.
• Manage PBM contractual credits including reporting, validation, and QA processes.
• Enforce PBM contractual obligations and regulatory requirements.
• Serve as SME for pharmacy benefits including design and configuration.
• Draft and coordinate PBM performance-related penalties and actions.
• Support contract governance activities and escalation/resolution tracking.
• Monitor call center performance metrics and drive improvement for member experience.
• Track eligibility changes and assess impact on performance and operations.
• Identify gaps and develop corrective action plans.

Skills

PBM knowledge

Analytical skills

Contract interpretation

Communication

Attention to detail

Cross-functional collaboration

Executive communication

Education

Bachelor's degree in healthcare administration, Pharmacy, Business Administration, Public Health

Tools

Tableau

Power BI

Job description

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

You will manage PBM performance, ensure contractual compliance, and provide data-driven insights to guide strategic decisions that improve member outcomes. The role requires at least 5 years in PBM/pharmacy operations or federal health program administration, with strong analytical, reporting, and cross-functional collaboration skills.