Manager of Pharmacy Implementation (G14)

UNITE HERE HEALTH serves over 200,000 workers and their families in the hospitality and gaming industry nationwide. Our desire to be innovative and progressive drives us to develop impactful programs and benefits designed to engage our participants in managing their own health and healthcare. Our vision is exciting and challenging. Please read on to learn more about this great opportunity!

The Manager of Pharmacy manages and leads the end-to-end onboarding and integration of new members, plans, and services within the pharmacy benefit management (PBM) environment. This role ensures the accurate and timely execution of benefit designs, eligibility file setup, formulary and network configurations, and compliance with regulatory and contractual requirements.

Essential Job Functions And Duties

• Lead and manage end-to-end client implementation projects, ensuring delivery on time, within scope, and to quality standards
• Serve as the primary liaison between clients, internal departments (e.g., Clinical, IT, Claims, Compliance, Account Management), and third-party vendors during implementation projects
• Oversee the setup of benefit plans, eligibility files, formulary design, and pharmacy network integration in accordance with PBM specifications
• Facilitate requirements gathering sessions and translate departmental needs into actionable implementation plans
• Monitor and manage project timelines, deliverables, risks, and change requests throughout the implementation lifecycle, as well as conduct post-implementation reviews
• Develop and maintain comprehensive project documentation, including implementation plans, status reports, test cases, and issue logs
• Coordinate internal testing and client User Acceptance Testing (UAT) to ensure benefit accuracy and operational readiness
• Ensure compliance with HIPAA, CMS, and other applicable regulatory guidelines during implementation activities and for PBM licensure
• Coordinate and help leading RFP / RFI / Consultant reviews for HospitalityRx
• Lead development of SPR / BPR resolutions and serve as intermediary for accounts related to HospitalityRx
• Mentor and support implementation specialists or coordinators on assigned projects
• Engages with consultants as needed and provides requested information, and works with external contacts to complete requests or projects related to PBM benefits
• Collaborates with other departments in maintaining and providing Pharmacy benefit information (e.g., Analytics, Legal, Finance) and assists in maintaining accurate benefit information on PBM website
• Assists in maintaining, editing, and implementing clinical edits and formulary files as needed
• Manages in development and implementation of Annual Transparency Reporting requirements
• Track annual progress of OOP accumulators and annual/lifetime Plan maximums and provide communication to impacted members when needed
• Prepare Plan summaries for determination of creditable coverage status, file annual CMS creditable coverage disclosure
• Anticipates potential issues with vendors not meeting agreed upon performance guarantees in the areas of rebates and copay assistance
• Reinforces the development and coordination of policies and procedures
• Plans, analyzes, and evaluates programs and services, operational needs, and fiscal constraints
• Supervises, leads, and delegates work and coaches, mentors, develops employees
• Analyzes problems, identifies, and develops alternative solutions, projects consequences of proposed actions, and implements recommendation/solutions
• Assists with developing and coordinating policies and procedures
• Responsible for the oversight of continued employee training requirements, safety, and quality initiatives
• Exemplifies the Fund’s values in leading and fostering a respectful, trusting, and engaged culture of inclusion and engagement
  
  

Essential Qualifications

• 7 ~ 10 years of direct experience minimum, working in a PBM organization
• 2 ~ 3 years of supervisor experience required
• 2+ years of experience in client onboarding or implementation project management
• Bachelor's degree in Healthcare Administration, Business, Information Systems, or related field
• Strong understanding of PBM operations, including benefit plan design, formulary management, claims adjudication, and eligibility processing
• Demonstrated ability to manage complex projects with multiple stakeholders
• Excellent verbal and written communication, client-facing, and organizational skills
• Familiarity with claims processing systems (e.g., RxCLAIM, Medispan, First Databank)
• Proficiency with project management tools (e.g., MS Project, Jira, Smartsheet) and Microsoft Office Suite
  
  

Salary range for this position: Salary $103,300 - $129,100. Actual base salary may vary based upon, but not limited to: relevant experience, qualifications, expertise, certifications, licenses, education or equivalent work experience, time in role, peer and market data, prior performance, business sector, and geographic location.

Work Schedule (may vary to meet business needs): Monday~Friday, 7.5 hours per day (37.5 hours per week) as a hybrid employee with travel TBD.

We reward great work with great benefits, including but not limited to: Medical, Dental, Vision, Paid Time-Off (PTO), Paid Holidays, 401(k), Short- & Long-term Disability, Pension, Life, AD&D, Flexible Spending Accounts (healthcare & dependent care), Commuter Transit, Tuition Assistance, and Employee Assistance Program (EAP).