PBM Operations Manager

Who We Are

Machinify is a leading healthcare intelligence company with expertise across the payment continuum, delivering unmatched value, transparency, and efficiency to health plan clients across the country. Deployed by over 60 health plans, including many of the top 20, and representing more than 160 million lives, Machinify brings together a fully configurable and content-rich, AI-powered platform along with best-in-class expertise. We're constantly reimagining what's possible in our industry, creating disruptively simple, powerfully clear ways to maximize financial outcomes and drive down healthcare costs.

Location: This position will be hybrid located in our La Grange, KY office (change location).

About the Opportunity

At Machinify, we're constantly reimagining what's possible in our industry-creating disruptively simple, powerfully clear ways to maximize our clients' financial outcomes today and drive down healthcare costs tomorrow. As part of the Pharmacy Operations team, you will lead the delivery of our payment integrity services for Pharmacy Benefit Managers (PBMs). This includes designing technical specifications, monitoring program performance, collaborating with software engineers, project management, and interfacing with clients - all to ensure our programs lead the industry with unmatched intelligence and reliability. This role requires strong analytical and communication skills to collaborate across departments and with external partners.

What you'll do

• Product ownership and oversight
  
  
  
  • Develop subject matter expertise in our payment integrity solutions for PBMs and other intelligence-based products
  • Collaborate with operations leadership to define the product vision and innovation roadmap at both macro and micro levels
  • Craft clear business requirements for our software engineers that consider current capabilities, customer needs, and best practices for future state
  
  
  
  
• Performance analysis
  
  
  
  • Develop and monitor reporting on all key program outputs to ensure financial and service-level objectives are met
  • Independently identify and investigate anomalies, determine root cause, and recommend remediation strategy
  
  
  
  
• Quality assurance - Sample and review outbound reporting to ensure completeness and accuracy
• Implementation support - Serve as lead representative of business operations for new client implementations
• Industry engagement and knowledge development - Attend and contribute to relevant NCPDP (National Council for Prescription Drug Programs) task groups

What experience you bring (Role Requirements)

• Bachelor's degree in Healthcare Administration, Business, Pharmacy, or related field
• 5+ years of experience in PBM/Pharmacy/Health plan background preferred
• Excellent organizational, analytical and problem-solving skills.
• Proven ability to manage complex projects
• Professional communication, interpersonal skill and presentation skills
• High energy level, motivated to grow business and be recognized for it
• Advanced Technical Skills in Excel required, SQL skills preferred

What Success Looks Like...

After 3 months

You will have a strong understanding of the role.

You begin building relationships and collaborating with peers.

You develop effective time and priorities management.

You receive initial feedback about your performance and are using it to improve.

You've gained confidence in your abilities and are starting to feel more comfortable in your role.

After 1 year

You have mastered the tasks and responsibilities of the position, executing them with confidence and efficiency.

You have established a strong network of internal relationships and are recognized as a key collaborator.

You've been entrusted with greater responsibility indicating the company's confidence in your abilities.

You see opportunities for career progression and personal development.

Pay range: This is an exempt position. The salary range is for Base Salary.Compensation will be determined based on several factors including, but not limited to, skill set, years of experience, and the employee's geographic location.

What's in it for you

• Flexible Time Off (FTO)
• Eligibility for health, vision and dental coverage, 401(k) plan participation with company match, and flexible spending accounts
• Tuition Reimbursement
• Eligibility for company-paid benefits including life insurance, short-term disability, and parental leave.
• Remote and hybrid work options

At Machinify, we're reimagining a simpler way forward. This begins with our employees. We are innovators who value integrity, teamwork, accuracy, and flexibility. We do the right thing, and we listen to the needs of our clients and their members. As tenured experts with unmatched experience, we champion diverse perspectives that help us to better understand and serve our clients.

Our values come to life through our culture. We embrace flexible working arrangements that allow our employees to bring innovation to life in the way that best suits their productivity. We work cross-functionally, abandoning silos, to bring innovative, accurate solutions to market. We invest in each other through ongoing education and team celebrations, and we give back to our communities through dedicating days for volunteering. Together, Machinify is making healthcare work better for everyone, and we're passionate about a future with better outcomes for all.

We are committed to equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender, gender identity or expression, or veteran status. We are proud to be an equal opportunity workplace. Machinify is an employment at will employer.

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