Senior Project Manager II, Pharmacy Value Programs

Senior Project Manager II, Pharmacy Value Programs

The Pharmacy Value Programs Senior Project Manager will lead the development, execution, and continuous improvement of innovative pharmacy benefit cost-savings programs across all lines of business, including Commercial, Exchange, Medicare, and Medicaid. In this highly cross-functional role, the Program Manager partners closely with internal teams, external vendors, and pharmacy partners to design and implement strategic initiativesfrom specialty pharmacy partnerships to benefit design optimization and manufacturer-direct solutionsthat reduce overall drug spend while maintaining or enhancing member experience. This role is responsible for maintaining detailed implementation plans, operational workflows, and training materials while ensuring program quality and compliance through structured audits and documentation. The Project Manager also collaborates with Analytics to produce opportunity assessments and savings reporting, and supports the commercialization of new offerings through pricing, marketing enablement, and RFI/RFP contributions. The ideal candidate brings deep experience in healthcare cost management, strong analytical capabilities, exceptional communication skills, and a strategic mindset with the ability to identify inefficiencies and drive long-term product and process improvements in a fast-paced environment.

Position Responsibilities:

• Program Development & Management: Collaborate with key stakeholders to develop and maintain new and existing drug cost containment programs for all lines of business (Commercial, Exchange, Medicare, and Medicaid). Programs include, but are not limited to, partnerships with innovative mail & specialty pharmacies, benefit design optimization, and integration with manufacturer direct offerings.
• Program Planning and Execution: Engage with appropriate stakeholders and cross-functional teams to ensure successful implementation and execution of programs.
• Program Maintenance: Regularly update and maintain comprehensive implementation plans, workflow guides, trainings, and other documentation.
• Quality Assurance: Implement quality control processes to ensure program compliance with established standards and guidelines. Conduct and document audits and work with appropriate stakeholders to implement corrective actions as needed.
• Vendor management: Own relationships with and provide oversight of third-party vendors (including pharmacies) to administer programs with emphasis on member experience and cost savings.
• Data Analytics & Reporting: Use reporting tools and partner with our Analytics team to develop and maintain opportunity analyses and ongoing savings performance reporting.
• Commercialization: Support the go-to-market strategy of savings product offerings including pricing, marketing, and implementation. Support RFI and RFP submissions.
• Continuous quality improvement: Evaluate evolving industry and market landscape and analyze prescription claims data to identify opportunities for improving existing products and developing new products. Supports quality improvement programs/projects as required.

Required Qualifications:

• Bachelor's Degree required
• 4+ years of experience applicable to health care cost management, such as in a health plan, PBM, value-based care, or managed care environment; consulting, advising, or tech enablement focused on the preceding areas also considered applicable
• Ability to balance multiple complex projects simultaneously with minimal direction
• Great time-management and organizational skills to manage multiple active projects simultaneously
• Exceptional written, verbal, and presentation skills
• Experience working with data reporting tools, conducting data analyses, and effectively consuming/interpreting data reports and visualizations

Preferred Qualifications:

• Master's Degree in relevant field (PharmD, MBA, MHA/MHP, etc.)
• Experience with prescription drug channels and payment workflows (pharmacy reimbursement, rebate administration and GPO relations, regulatory requirements, etc.)
• Experience with health insurance or health benefits administration (pharmacy benefits in particular)
• Strong experience in developing, implementing, and using data and workflow management technology solutions (e.g., customer relationship management (CRM), Jira/Salesforce, collaborative Excel workbooks in SharePoint, etc.)
• Experience with programming languages relevant to data analytics, such as SQL or Python
• Proficient in Microsoft Office Suite with emphasis on Microsoft Excel and PowerPoint
• Ability to think strategically and identify inefficiencies, develop long-term solutions, and challenge and improve existing processes through automation and redesign
• Highly detail-oriented and analytical
• Ability to travel occasionally as needed for internal, client, and vendor/partner meetings

Salary Ranges:

• New York, NY: $131,600 - $164,500 USD
• Denver, CO: $120,400 - $150,500 USD
• Charlotte, NC: $109,600 - $137,000 USD

All employees are responsible for adherence to the Capital Rx Code of Conduct including the reporting of non-compliance. This position description is designed to be flexible, allowing management the opportunity to assign or reassign duties and responsibilities as needed to best meet organizational goals.

We provide equal employment opportunities to all employees and applicants for employment and prohibit discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, medical condition, genetic information, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.