RxSense

Operations Lead - Government Pharmacy Benefit Management

Remote

Auto‑apply with AI Apply

Not SpecifiedCompensation

Mid-level (3 to 4 years), Senior (5 to 8 years)Experience Level

Full TimeJob Type

UnknownVisa

Healthcare, FintechIndustries

Requirements

Candidates should possess a Bachelor’s degree in a related field, along with a minimum of 5 years of experience in operations, preferably within the healthcare or pharmacy benefit management industry. Strong leadership and organizational skills are essential, as is the ability to manage complex workflows and implement scalable infrastructure. Experience with government healthcare programs, specifically Medicare Part D, Medicaid, and ACA marketplace plans, is highly desired.

Responsibilities

The Operations Lead will design and implement comprehensive PBM operational infrastructure and workflows for government healthcare programs, establishing service delivery standards that meet regulatory requirements. They will oversee prescription drug claims processing systems, manage formulary administration, and develop mail-order pharmacy operations and specialty pharmacy services. Furthermore, the role involves serving as a cross-functional leader, collaborating with compliance and clinical teams to integrate regulatory requirements and medication therapy management (MTM) services.

Skills

PBM operations

Medicare Part D

Medicaid

ACA marketplace plans

CMS

RxSense

Pharmacy benefits management technology solutions

About RxSense

RxSense provides technology solutions for the pharmacy benefits management (PBM) industry, focusing on simplifying and optimizing the management of pharmacy benefits and claims. Its main product is an enterprise platform that integrates real-time business intelligence and analytics, allowing PBMs to gain actionable insights and make informed decisions to improve their operations. This platform is modular, enabling clients to customize their use and enhance care delivery. RxSense differentiates itself from competitors by offering APIs that ensure interoperability between different systems, complying with industry standards. The company's goal is to transform the PBM industry by providing tools that enhance efficiency and empower clients with timely data and insights.

Key Metrics

Boston, MassachusettsHeadquarters

2015Year Founded

GROWTH_EQUITY_VCCompany Stage

Data & Analytics, HealthcareIndustries

201-500Employees

Risks

Increased competition in the PBM space may pressure RxSense to innovate rapidly.

Partnership with Walgreens may expose RxSense to regulatory challenges.

Investment from Parthenon Capital could lead to strategic shifts causing internal disruptions.

Differentiation

RxSense offers a modular platform with real-time analytics for PBMs.

The company provides APIs compliant with FHIR and NCPDP standards for interoperability.

RxSense's platform delivers actionable insights for data-driven decision-making in pharmacy benefits.

Upsides

Partnership with Walgreens enhances consumer access to prescription discounts nationwide.

Growing demand for cloud-based healthcare solutions aligns with RxSense's offerings.

Collaboration with Scipher Medicine integrates precision medicine into pharmacy benefits management.

Land your dream remote job 3x faster with AI

Try Jobo Free