Pharmacy Manager, Benefit Operations - Emory Health Plan

Emory University•Atlanta, GA

10h

About The Position

The Pharmacy Manager, Benefit Operations (Emory Health Plan) serves as the primary operational liaison between the Emory Health Plan (EHP) Pharmacy division and the Pharmacy Benefit Manager (PBM).

Requirements

Doctor of Pharmacy (PharmD) from an accredited School of Pharmacy. 3+ years of clinical pharmacy, managed care, or health system experience.
Demonstrated leadership experience within a pharmacy setting, including oversight of clinical, operational, or administrative function.
Strong knowledge of drug therapy, formulary management, evidence evaluation, and population health principles.
Experience working with PBMs.
Experience managing ongoing external vendor relationships.
Ability to engage effectively with patients, vendors, physicians, clinical leaders, and multidisciplinary teams.
Strong analytical and communication skills are important.
Strong project management and organizational skills are essential.

Nice To Haves

Completion of PGY1 residency preferred in pharmacy practice, managed care, ambulatory care, population health, or pharmacotherapy.
Prior experience within a health plan, PBM, IDN, or specialty pharmacy setting.
Experience with utilization management criteria, project management, outcomes measurement, or quality improvement programs.
Familiarity with medical + pharmacy benefit integration and specialty drug management.

Responsibilities

Ensures accurate and timely implementation of all pharmacy benefit configurations, formulary and UM updates, specialty drug programs, and plan design elements.
Provides day-to-day oversight, leads implementation cycles, validates system accuracy, and supports overall plan performance, financial stewardship, and member experience.
Serves as the main contact for all PBM configuration activities and benefit builds.
Reviews/approves PA criteria, clinical edits, copay rules, accumulators, NDC exclusions, and formulary updates.
Conducts ongoing audit, testing, and documentation of all configuration elements, including NDC crosswalks and specialty drug rules.
Leads daily/weekly/monthly operational touchpoints with the PBM to review performance and configuration changes.
Investigates and resolves claim processing issues, benefit errors, and member escalations.
Collaborates with Emory Specialty Pharmacy, Ambulatory Operations, and clinical teams to ensure alignment.
Manages pharmacy configuration for open enrollment, new plan launches, mid-year benefit updates, and special programs.
Maintains project plans, timelines, testing cycles, and validation reports.
Oversees approval and tracking of PBM change requests and configuration tickets.
Reviews formulary placement, exclusions, and UM rule changes for accuracy and impact. Translates clinical policies into system edits in partnership with Pharmacy Clinical Programs.
Maintains a centralized formulary + UM rules source of truth for governance and compliance.
Validates rebate classifications, NDC/J-code crosswalks, specialty lists, and accumulator logic.
Ensures compliance with CMS, DOL, ERISA, and internal EHP audit requirements.
Partners with IT, legal, and compliance to ensure secure and accurate data flow.
Monitors daily/weekly adjudication dashboards, denied-claim trends, and high-cost drug utilization.
Identifies root causes of configuration or operational issues and recommend improvements.
Works with analytics teams to assess benefit design impact and trend drivers.
Provides expert guidance on benefit interpretation and PBM operations to internal stakeholders.
Collaborates with vendor management, clinical programs, specialty pharmacy, and member services.
Presents updates to EHP leadership, governance committees, and benefit oversight groups.