Site: Mass General Brigham Health Plan Holding Company, Inc.
Mass General Brigham relies on a wide range of professionals, including doctors, nurses, business people, tech experts, researchers, and systems analysts to advance our mission. As a not-for-profit, we support patient care, research, teaching, and community service, striving to provide exceptional care. We believe that high-performing teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham.
Job Summary
Mass General Brigham Health Plan is an exciting place to be within the healthcare industry. As a member of Mass General Brigham, we are at the forefront of transformation with one of the world’s leading integrated healthcare systems. Together, we are providing our members with innovative solutions centered on their health needs to expand access to seamless and affordable care and coverage.
Our work centers on creating an exceptional member experience – a commitment that starts with our employees. Working with some of the most accomplished professionals in healthcare today, our employees have opportunities to learn and contribute expertise within a welcoming and supportive environment that embraces their unique and varied backgrounds, experiences, and skills.
We are pleased to offer competitive salaries and a benefits package with flexible work options, career growth opportunities, and much more.
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.
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.
Education
- Bachelor's Degree Related Field of Study required; experience can be considered in lieu of a degree
Licenses and Credentials
- Pharmacy Technician license preferred
- Pharmacy Technician Certification license preferred
Experience
- 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.
Additional Job Details (if applicable)
Working Conditions
- This is a full-time role with a Monday through Friday schedule, generally 9:00 AM to 5:30 PM Eastern Time
- This position is eligible for remote work from approved U.S. locations, subject to organizational requirements
- Remote employees must maintain a stable internet connection and a secure, private, quiet workspace appropriate for handling confidential and protected health information
- Remote workspace requirements, including privacy and security standards, may be verified in accordance with organizational policy
Remote
399 Revolution Drive
40
Regular
Day (United States of America)
Pay Range
$63,648.00 - $92,570.40/Annual
Grade
6
At Mass General Brigham, we believe in recognizing and rewarding the unique value each team member brings to our organization. Our approach to determining base pay is comprehensive, and any offer extended will take into account your skills, relevant experience if applicable, education, certifications and other essential factors. The base pay information provided offers an estimate based on the minimum job qualifications; however, it does not encompass all elements contributing to your total compensation package. In addition to competitive base pay, we offer comprehensive benefits, career advancement opportunities, differentials, premiums and bonuses as applicable and recognition programs designed to celebrate your contributions and support your professional growth. We invite you to apply, and our Talent Acquisition team will provide an overview of your potential compensation and benefits package.
8925 Mass General Brigham Health Plan Holding Company, Inc. is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment. To ensure reasonable accommodation for individuals protected by Section 503 of the Rehabilitation Act of 1973, the Vietnam Veteran’s Readjustment Act of 1974, and Title I of the Americans with Disabilities Act of 1990, applicants who require accommodation in the job application process may contact Human Resources at (857)-282-7642.
Mass General Brigham Competency Framework
At Mass General Brigham, our competency framework defines what effective leadership “looks like” by specifying which behaviors are most critical for successful performance at each job level. The framework is comprised of ten competencies (half People-Focused, half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and car