Manager, Pharmacy Operations

Remote

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Not SpecifiedCompensation

Senior (5 to 8 years), Expert & Leadership (9+ years)Experience Level

Full TimeJob Type

UnknownVisa

Healthcare, Health Benefits, Pharmacy Benefit ManagementIndustries

Requirements

Candidates should possess 5+ years of experience in PBM operations, pharmacy claims, or health plan pharmacy departments, with at least 2 years in vendor management, claim auditing, or pharmacy benefits analysis. Familiarity with Medical Pharmacy claims (J-Codes, S-Codes, C-Codes) and formulary management is required, along with strong analytical, data-driven problem-solving, communication, and collaboration skills. Proven ability to prioritize and manage multiple projects simultaneously is essential.

Responsibilities

The Manager, Pharmacy Operations will oversee daily PBM functions and vendor relationships, focusing on operational execution including claim review, audit support, and reporting. Responsibilities include reviewing pharmacy claims for issues and potential fraud, monitoring PBM FW&A reporting, supporting the PBM audit program, managing pharmacy vendor activities, and overseeing pharmacy benefit and formulary configuration. The role also involves collaborating with the Marketing team on communications, performing quality reviews of Utilization Management and Prior Authorization cases, supporting internal stakeholders with pharmacy benefit inquiries, and continuously improving PBM processes, tools, and reporting.

Skills

Pharmacy Operations

PBM

Vendor Management

Claim Review

Audit Support

Reporting

Fraud, Waste, and Abuse (FW&A)

Formulary Configuration

Utilization Management (UM)

Prior Authorization (PA)

Billing Reconciliation

Cross-functional Collaboration

Gravie

Health benefits and insurance solutions provider

About Gravie

Gravie provides health benefits by offering straightforward and affordable health plans, primarily targeting individuals and small to midsize businesses. Their main product, Comfort, stands out because it has no deductible and no copays for most common healthcare services, allowing members to access care without unexpected costs. Additionally, Comfort includes virtual care options for musculoskeletal and mental health issues. Gravie also offers a payment solution called Gravie Pay, which enables members to pay for healthcare expenses interest-free, further easing financial stress. Unlike traditional health plans, Gravie claims that Comfort members save on out-of-pocket costs, and employers switching to Gravie often see lower premium expenses. The company has a high retention rate, indicating that many employees choose to continue with the Comfort plan in subsequent years. Gravie's goal is to simplify health benefits and reduce the financial burden of healthcare for its members.

Minneapolis, MinnesotaHeadquarters

2013Year Founded

$333.3MTotal Funding

DEBTCompany Stage

Fintech, HealthcareIndustries

201-500Employees

Benefits

Health Insurance

401(k) Retirement Plan

401(k) Company Match

Paid Holidays

Paid Vacation

Paid Sick Leave

Flexible Work Hours

Paid Parental Leave

Wellness Program

Alternative Medicine Coverage

Cell Phone Reimbursement

Transportation Perks

Education Reimbursement

Paid Paw-ternity Leave

Risks

Potential backlash from traditional insurers could increase competition or lobbying.

Rapid ICHRA adoption may invite regulatory scrutiny or changes.

Aggressive expansion strategy could strain resources and lead to inefficiencies.

Differentiation

Gravie's Comfort plan offers zero deductibles and copays, unlike traditional health plans.

Gravie Pay provides interest-free payment solutions, reducing financial burdens for members.

Focus on virtual healthcare services enhances accessibility and member satisfaction.

Upsides

Increased ICHRA adoption since 2020 expands Gravie's market opportunities.

Comfort plan's zero-deductible model attracts cost-conscious employers and employees.

Virtual healthcare services align with rising demand, boosting member engagement.

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