Product Manager - Pharmacy Benefits Management - Columbus, OH

Position Overview

This role is responsible for managing and enhancing Pharmacy Benefits products. You will work closely with Health Plan Product Development, Marketing, Pharmacy, and other teams to design, implement, and monitor benefit modifications in diverse systems while ensuring regulatory compliance and excellent customer service.

Key Responsibilities

• Liaise with Health Plan Product Development and Marketing to design, implement, and administer new Pharmacy Benefits products, including updates to Pharmacy Information Management Systems, Membership and Eligibility, and other systems.
• Collaborate with Health Plan Product Development and Marketing to design, develop, and implement new Pharmacy Benefits and modifications to existing benefits.
• Ensure successful programming and implementation of new or modified benefits language and terms into relevant systems.
• Coordinate with Pharmacy and Health Plan leaders to implement benefits at customer interfaces on both internal and external systems.
• Implement, administer, and monitor Commercial, Medicare, Self-funded, Exchanges, and Medicaid drug benefits, including formulary and benefit updates as well as member eligibility feeds.
• Monitor pharmacy fee schedules with operational updates to ePIMS systems and CMS reporting for Medicare Plan Finder.
• Oversee pharmacy benefit technical functions including reporting, remediation, Prescription Drug Events, and monitoring.
• Provide expert feedback on proposed regulations and legislation affecting pharmacy benefits.
• Manage pharmacy benefit vendors, overseeing claim adjudication, audits, network management, and other administrative activities.
• Participate in the marketing and education initiatives for both health plan staff and external audiences regarding Pharmacy Benefits.
• Develop pharmacy responses for Requests for Proposals from employer groups for regional and national accounts.

Benefits & Perks

• Competitive compensation package commensurate with experience.
• Annual bonus potential based on productivity and performance.
• Paid time off from the start, including paid holidays and vacation time.
• Full benefits package including medical, dental, and vision plans.
• A positive work environment with excellent job satisfaction, a hard working team, flexible upper management, and the ability to act as the captain of your ship.