Senior Director, Pharmacy and PBM Operations

Progyny•New York, NY

1d•Hybrid

About The Position

Thank you for considering Progyny! The Pharmacy and PBM Operations Leader will oversee and manage Progyny’s pharmacy benefit management (PBM) program, driving operational excellence at both tactical and strategic levels. This role is responsible for leading end-to-end PBM and pharmacy-related operational projects, ensuring seamless integration of new programs and services, and serving as a strategic partner to leadership. The ideal candidate will possess deep industry expertise, strong leadership capabilities, and a visionary mindset to drive innovation and continuous improvement in a dynamic, high-growth environment.

Requirements

12+ years of extensive experience in PBM operations, including interaction with self-funded and employer-sponsored health plan benefits.
Comprehensive knowledge of PBM/pharmacy/healthcare industry, PBM operations, third party administrators, benefit setup (ASO and fully-insured), pharmacy claims, and managed care.
Strong understanding of PBM processes: claims adjudication, network development, pricing, analytics/reporting, rebates, clinical aspects, trade, contracting, systems, and account management.
Experience negotiating contracts with PBMs and pharmacies.
Visionary mindset with the ability to anticipate and navigate emerging changes in the healthcare landscape and identify innovative solutions to complex challenges.
Exceptional communication skills to convey complex PBM/pharmacy concepts to diverse stakeholders, fostering clear understanding and driving organizational success.
Proven change agent with the ability to initiate and lead initiatives, motivate teams, and foster a culture of adaptability, high performance, accountability, excellence, and continuous improvement.
High proficiency in project management methodologies for effective planning, execution, and monitoring of key initiatives, ensuring timely delivery of results.
Strong analytical and problem-solving skills with attention to detail for addressing complex operational challenges.
Ability to manage expectations and facilitate understanding at all organizational levels, both internally and externally.
Capacity to lead, oversee, prioritize, and handle multiple projects and clients with dynamic and shifting timelines, utilizing proven project management processes.
Demonstrated success in driving operational excellence and executing process improvements in a high-growth, fast-paced, entrepreneurial business setting, with a focus on measuring results and achieving targeted outcomes.

Nice To Haves

Doctor of Pharmacy preferred.
Knowledge of accreditation standards (URAC, ACHC) is a plus.

Responsibilities

Oversee and manage key PBM/pharmacy programs, providing operational leadership at both tactical and strategic levels.
Develop, support, and execute end-to-end lifecycle of PBM/pharmacy-related operational projects and deliverables.
Serve as the primary contact for PBM/pharmacy trading partners.
Implement and enhance operational processes to improve efficiency, accuracy, and customer satisfaction.
Collaborate with cross-functional teams for seamless integration of new programs and services.
Monitor and analyze key performance indicators to identify areas for improvement and optimization.
Act as a thought partner, sounding board, and strategic advisor to Progyny leadership and cross-functional partners.
Provide analysis, recommendations, and options regarding high-impact decisions.
Support the rebate management process from both trading partner and employer client perspectives.

Benefits

Family friendly benefits: Paid family and parental leave, preconception , fertility and family building benefits (including egg freezing, IVF, and adoption support), family and pet care fund , and Parents’ Employee Affiliation Group
Menopause and midlife care
Health, dental, vision and life insurance options for employees and family
Free in-person, virtual and text-based mental health and wellness support
Paid time off, including vacation, sick leave, personal days and summer flex time
Company equity
Bonus program
401(k) plan with company match
Access to on-demand legal and financial advice
Learning and development programs to help you grow professionally and a mentorship program
Company social events to include annual volunteer day and donation matching
Flex days (3 days a week in the office) and onsite meals and snacks for employees reporting into our NY office