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Pbm Analyst Jobs in Michigan (NOW HIRING)

Epitec, Inc.

Health Care Analyst

Detroit, MI · On-site

Responsible for identifying, collecting, analyzing, and maintaining data to evaluate issues that ... Knowledge of BCBSM's prescription drug programs and the PBM industry is a plus. Additional ...

CVS Health

MI · On-site

$110K - $249K/yr

... analyzing drug utilization patterns and trends for our Pharmacy Benefit Management (PBM) clients. In this role, you will be focusing on the clinical aspects of clients' benefit plans, as well as ...

McLaren USA

Pharmacy Program Manager, Michigan

Flint, MI · On-site

$63.25 - $74.50/hr

This position serves as the operational bridge between McLaren Health Plan and its PBM partner ... data analytics platforms, reporting tools, or business intelligence systems. • Two (2) years ...

McLaren

Pharmacy Program Manager, Michigan

Flint, MI · On-site

$63.25 - $74.50/hr

This position serves as the operational bridge between McLaren Health Plan and its PBM partner ... data analytics platforms, reporting tools, or business intelligence systems. • Two (2) years ...

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Pbm Analyst information

What are some common challenges PBM analysts face when working with large healthcare data sets?

PBM Analysts often work with complex and highly sensitive healthcare data, which can pose challenges in terms of data integrity, accuracy, and privacy. Ensuring data is consistently clean and up to date requires strong attention to detail and proficiency with analytical tools. Additionally, analysts must regularly collaborate with cross-functional teams, such as clinical staff and IT, to reconcile data discrepancies and implement effective solutions, making communication skills essential for success.

What is the difference between Pbm Analyst vs Pbm Coordinator?

AspectPbm AnalystPbm Coordinator
CredentialsTypically requires a bachelor's degree in healthcare, pharmacy, or related field; certifications like CPC or CPhT are commonSimilar educational background; may also hold certifications but often less specialized
Work EnvironmentWorks in healthcare or pharmacy benefit management companies, analyzing data and optimizing formulariesSupports daily operations, manages provider and client communications within healthcare settings
Employer & Industry UsageUsed in pharmacy benefit management, health insurance, and healthcare organizationsCommon in healthcare administration, pharmacy services, and insurance companies

The Pbm Analyst and Pbm Coordinator roles share similar educational backgrounds and work environments within healthcare and pharmacy benefit management. However, Pbm Analysts focus more on data analysis and formulary optimization, while Pbm Coordinators handle operational support and client communications. Both roles are essential in healthcare organizations but differ in their primary responsibilities.

What is a PBM analyst?

A PBM Analyst is a professional who works within the pharmacy benefit management (PBM) industry, focusing on analyzing data related to prescription drug benefits, costs, and utilization. Their role typically involves evaluating pharmacy claims, identifying trends, and generating reports to help optimize drug benefit plans for employers, insurers, or PBM companies. PBM Analysts play a critical role in controlling costs, ensuring compliance with regulations, and improving patient outcomes by providing actionable insights based on data. They often work with cross-functional teams, including pharmacists, IT specialists, and healthcare providers. Strong analytical skills and knowledge of healthcare data and pharmacy operations are essential for this role.

What are the key skills and qualifications needed to thrive as a PBM analyst, and why are they important?

To thrive as a PBM Analyst, you need strong analytical skills, knowledge of pharmacy benefit management processes, and a background in healthcare or pharmacy, often supported by a relevant degree. Familiarity with data analysis tools like SQL, Excel, and pharmacy claims processing systems is typically required. Attention to detail, effective communication, and problem-solving abilities help you excel in collaborating with stakeholders and interpreting complex data. These skills ensure accurate analysis, compliance, and the optimization of pharmacy benefit programs for clients and members.
What are popular job titles related to Pbm Analyst jobs in Michigan? For Pbm Analyst jobs in Michigan, the most frequently searched job titles are:
What job categories do people searching Pbm Analyst jobs in Michigan look for? The top searched job categories for Pbm Analyst jobs in Michigan are:
What cities in Michigan are hiring for Pbm Analyst jobs? Cities in Michigan with the most Pbm Analyst job openings:
Pbm Analyst jobs near you
Infographic showing various Pbm Analyst job openings in Michigan as of August 2026, with employment types broken down into 1% Internship, 83% Full Time, 8% Part Time, 1% Temporary, and 7% Contract. Highlights an 80% Physical, 10% Hybrid, and 10% Remote job distribution.

PBM Partnerships & Payer Relations Manager

Insight

Flint, MI • On-site

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted yesterday

Job description

Insight Health System is a physician-led organization focused on advancing excellence in healthcare and community well-being. Our expertise is in transforming distressed hospitals into stable, patient-centric care that is second to none. With a track record for innovation in healthcare, research and development, Insight Health System provides the communities we serve with world-class healthcare services at the forefront of medical technology. Our network currently includes a portfolio of entities encompassing six acute care hospitals (three of which are nonprofit), six surgery centers, 28 clinics, 580 physicians, 10 unions, and 4,200 employees. Collectively, Insight Health System hospitals provide nearly 100,000 patient days annually.
Position Overview
We are seeking a proactive, relationship-driven PBM Partnerships & Payer Relations Manager to serve as the primary point of contact for Pharmacy Benefit Managers (PBMs), third-party administrators (TPAs), brokers, and self-funded employer groups. This role is responsible for building new partnerships, strengthening existing relationships, supporting contract execution, ensuring operational accuracy, and driving network growth across all payer and PBM channels. The ideal candidate excels at communication, problem-solving, and business development within the pharmacy or healthcare benefits ecosystem.
Benefits:
  • Comprehensive health, dental, and vision insurance
  • Paid time off: vacation, holidays, and sick leave
  • 401(k) with employer match (immediate vesting; eligibility begins after 3 months)
  • Employer - paid short - and long - term disability, basic life insurance
  • Voluntary coverages: accident, critical illness, hospital indemnity, AD&D, etc.

Key Responsibilities:
PBM Partnership Management
  • Serve as the main liaison for all PBM partners, contractors, TPAs, and associated vendors.
  • Manage onboarding, implementations, and ongoing communication to ensure alignment and strong operational performance.
  • Oversee contract execution, version control, and escalation resolution with external partners.
  • Proactively step in to assist with prior authorizations or operational duties as needed to ensure exceptional service continuity.
  • Maintain a clear understanding of PBM reimbursement strategies, plan designs, MAC pricing, and specialty pharmacy dynamics.
  • Step in to assist with PAs or operations during high-volume periods or staffing gaps.

Self-Funded Employer Network Development
  • Build new relationships with self-funded employers, brokers, benefits consultants, and employer coalitions.
  • Identify opportunities for employers to utilize the pharmacy as a preferred or direct-to-employer solution (specialty savings, infusion savings, carve-outs).
  • Present pharmacy value propositions, cost-savings models, and service offerings to employer groups.
  • Support the execution of direct-to-employer agreements and develop customized employer workflows.

Payer & Network Growth
  • Drive expansion into new PBM networks, payer groups, and employer health plans.
  • Research and pursue opportunities to improve reimbursement rates or negotiate favorable contract terms.
  • Track market trends, competitive pricing, and plan changes influencing pharmacy performance.
  • Strengthen ties with existing PBM and payer partners to secure long-term relationships.

Operational & Contract Coordination
  • Troubleshoot operational issues, adjudication errors, reimbursement discrepancies, and network constraints.
  • Collaborate with internal teams (legal, finance, operations, pharmacy) to ensure contractual accuracy and workflow alignment.
  • Maintain oversight of contract renewals, amendments, compliance obligations, and key dates.
  • Support renegotiation efforts by preparing comparisons, contract reviews, and partner summaries.

Performance Monitoring & Reporting
  • Track reimbursement patterns, adjudication behaviors, specialty margins, and PBM performance metrics.
  • Generate internal reporting to evaluate partnership effectiveness and financial outcomes.
  • Identify opportunities to optimize pricing strategies, improve patient access, and enhance profitability.

Relationship Building & Strategic Development
  • Cultivate strong, trust-based relationships with PBM executives, employer decision-makers, consultants, and industry partners.
  • Represent the organization at meetings, conferences, and strategic discussions.
  • Identify emerging opportunities for collaboration, market expansion, or product/service enhancement.

Required Qualifications
  • Bachelor's degree in Business, Healthcare Administration, Pharmacy, or a related field.
  • Experience working with PBMs, payers, networks, benefits administrators, or pharmacy operations.
  • Strong communication, negotiation, and relationship-management skills.
  • Ability to manage contracts, escalations, timelines, and multi-stakeholder relationships.
  • Strong analytical thinking, problem-solving skills, and organizational abilities.

Preferred Qualifications
  • Prior experience working directly with PBMs, TPAs, or self-funded employer groups.
  • Experience in specialty pharmacy, infusion services, or pharmacy network contracting.
  • Working knowledge of claim adjudication, reimbursement structures, MAC lists, spread pricing, and DIR fee models.
  • Experience building direct-to-employer pharmacy programs or benefit carve-out models.
  • Familiarity with value-based pharmacy programs, outcomes reporting, and data-driven performance metrics.
  • Strong understanding of healthcare contracting, payer policies, and benefits administration.
  • Ability to interpret contract terms, fee schedules, and reimbursement methodologies.
  • Experience presenting pharmacy solutions or savings programs to employers, payers, or consultants.
  • Existing relationships with PBMs, benefit brokers, employer groups, or industry partners is a major plus.

Insight is an equal opportunity employer and values workplace diversity!

Apply