Pharmacy Design Consultant
About The Position
This role is responsible for the end‑to-end development and ongoing maintenance of client Implementation Guides, which are essential for accurately configuring pharmacy benefits. The position requires expert-level knowledge of prescription benefits, strong systems proficiency, and the ability to interpret complex plan design documentation from other carriers. Pharmacy Design Consultant will partner closely with internal teams and external stakeholders to ensure that all plan designs align with client expectations while adhering to regulatory requirements and system capabilities.
Requirements
- Minimum of 3-5 years’ experience in pharmacy benefits, PBM operations or healthcare plan configuration
- Proven ability to interpret plan design documents from external carriers
- Knowledge of ACA mandates and state-specific benefit rules
- Strong time management and prioritization skills
- Excellent communication and collaboration skills
- Experience working cross-functionally with implementation or client-facing teams
- Extremely detail-oriented and organized
Nice To Haves
- Experience with benefit setup in a PBM system
- Familiarity with health plan or TPA operations
- Process improvement or documentation experience
- Prescription claims adjudication experience
Responsibilities
- Lead the end‑to-end creation, validation, loading and maintenance of pharmacy benefit plan designs/IG’s
- Develop and maintain client Implementation Guides, ensuring accuracy, clarity, and alignment with benefit requirements
- Translate complex client benefit requests into actionable system configurations within established capabilities
- Provide guidance to cross-functional teams, including Client Success, Operations, Compliance, and Operations
- Recommend best practices for benefit design to ensure accuracy, efficiency, and consistency across clients
- Provide support and 2nd set of eyes on all new client implementations testing
- Work closely with implementation teams to ensure smooth client onboarding and benefit transitions
- Support internal teams with benefit interpretation questions and technical clarifications
- Stay current on ACA requirements, state regulations, and clinical program capabilities
- Maintain version control and auditability of Implementation Guides
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
Number of Employees
1-10 employees
