Senior Pharmacy Operations Specialist
Mass General Brigham
Summary
The Senior Pharmacy Operations Specialist is a senior-level pharmacy operations professional responsible for ensuring the effective administration, implementation, monitoring, and continuous improvement of the pharmacy benefit for Commercial and Medicaid members. The role combines operational expertise, analytical problem-solving, vendor oversight, system implementation, regulatory support, and project leadership.
Job description
Essential Functions
- 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.
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.
The ideal candidate will also bring experience in one or more of the following areas: Supporting both Commercial and Medicaid pharmacy benefits, ideally for at least 1 year. Working directly with a PBM and/or health plan, including pharmacy benefit configuration, claims adjudication systems, and Medicaid/MassHealth pharmacy operations and regulatory requirements. Data analytics, reporting tools, or SQL, along with experience leading cross-functional projects and system implementations.
Knowledge, Skills, and Abilities
- Demonstrated ability to analyze complex operational issues and develop effective solutions.
- Strong organizational, project management, communication, and problem-solving skills.
- Proficiency with Microsoft Office, particularly Excel, and the ability to work with operational and claims data.
- Advanced knowledge of pharmacy benefit operations and managed care processes.
- Understanding of formulary management and utilization management programs.
- Strong analytical and investigative skills with the ability to identify root causes.
Requirements
- Bachelor's Degree in 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
- Experience supporting both Commercial and Medicaid pharmacy benefits, ideally for at least 1 year
- Experience working directly with a PBM and/or health plan, including pharmacy benefit configuration, claims adjudication systems, and Medicaid/MassHealth pharmacy operations and regulatory requirements
- Data analytics, reporting tools, or SQL experience
- Experience leading cross-functional projects and system implementations
- Demonstrated ability to analyze complex operational issues and develop effective solutions
- Strong organizational, project management, communication, and problem-solving skills
- Proficiency with Microsoft Office, particularly Excel, and the ability to work with operational and claims data
- Advanced knowledge of pharmacy benefit operations and managed care processes
- Understanding of formulary management and utilization management programs
- Strong analytical and investigative skills with the ability to identify root causes
Benefits
- Health insurance
- Flexible work options
- Career growth opportunities
- Competitive salary
Company overview
Mass General Brigham is one of the largest integrated healthcare delivery systems in the United States, formed through the merger of Massachusetts General Hospital and Brigham and Women's Hospital. Based in Boston, Massachusetts, this academic medical center system operates multiple hospitals, specialty facilities, and community health centers throughout New England. The organization is renowned for its world-class patient care, cutting-edge medical research, and comprehensive medical education programs. As a teaching affiliate of Harvard Medical School, Mass General Brigham trains the next generation of healthcare professionals while advancing medical science through groundbreaking research initiatives. The system provides a full continuum of healthcare services, from primary care and preventive medicine to complex specialty treatments and emergency services. With a focus on innovation and patient-centered care, Mass General Brigham consistently ranks among the top hospital systems in the nation for clinical excellence and research output.