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Pbm Compliance Jobs (NOW HIRING)

Pharmpix

PR · On-site

Monitor and interpret regulatory changes impacting PBM operations, including CMS guidelines, HIPAA, and Medicare Part D. * Assist in maintaining compliance with Medicare regulations, including ...

RSM Global

Market Conduct Examiner (Health and PBM)

Market Conduct Examiner (Health and PBM) Risk & Regulatory Consulting, LLC (Regulatory Insurance ... Recommend/document actions to ensure compliance with insurance statutes and regulations. * Must ...

WELLDYNE

PBM Rebate Analyst

Reviews and analyzes rebate reimbursements to ensure contract compliance. * Supports rebate related ... Previous PBM experience is a strong plus. Knowledge, Skills, and Abilities * Strong knowledge of ...

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How much do pbm compliance jobs pay per hour?

As of Aug 7, 2026, the average hourly pay for pbm compliance in the United States is $24.25, according to ZipRecruiter salary data. Most workers in this role earn between $18.27 and $26.44 per hour, depending on experience, location, and employer.

What are the key skills and qualifications needed to thrive as a PBM Compliance professional?

To thrive as a PBM Compliance professional, you need a strong understanding of pharmacy benefit management regulations, healthcare laws, and compliance protocols, often supported by a degree in healthcare, pharmacy, or a related field. Familiarity with regulatory research tools, compliance management systems, and auditing software is typically required, along with certifications such as Certified Compliance & Ethics Professional (CCEP) being advantageous. Attention to detail, ethical judgment, and strong communication skills help professionals navigate complex regulations and collaborate with cross-functional teams. These skills and qualifications are crucial to ensure adherence to legal requirements, minimize risk, and maintain the integrity of PBM operations.

What is PBM compliance?

PBM compliance refers to the adherence to regulations, laws, and contractual requirements governing Pharmacy Benefit Managers (PBMs). PBM compliance professionals ensure that PBMs operate within federal and state guidelines, particularly regarding drug pricing, patient privacy (such as HIPAA), and contracts with pharmacies and drug manufacturers. Their work helps prevent fraud, waste, and abuse in the prescription drug supply chain, protecting both patients and health plan sponsors. Compliance in this field is critical to maintaining transparency, ethical practices, and trust within the healthcare system.

What are some common challenges faced in a PBM Compliance role, and how can I prepare to address them?

Professionals in PBM (Pharmacy Benefit Manager) Compliance often navigate complex regulatory requirements and frequent changes in healthcare laws. Common challenges include staying updated with evolving state and federal regulations, ensuring internal processes remain compliant, and effectively communicating compliance expectations across departments. To prepare, candidates should develop strong attention to detail, keep current with industry updates, and build collaborative relationships with legal, clinical, and operational teams. Proactive learning and ongoing professional development are essential for success in this dynamic environment.

What is the difference between Pbm Compliance vs Pharmacy Technician?

AspectPbm CompliancePharmacy Technician
Required CertificationsOften requires PBM-specific certifications, compliance trainingCertified Pharmacy Technician (CPhT) typically required
Work EnvironmentFocus on PBM operations, regulatory compliance, auditsWork in retail, hospital, or mail-order pharmacies assisting pharmacists
Industry UsagePrimarily in pharmacy benefit management companiesIn various pharmacy settings across healthcare

While both roles are involved in pharmacy operations, Pbm Compliance specialists focus on regulatory adherence within PBMs, whereas Pharmacy Technicians assist pharmacists in daily pharmacy tasks. Understanding these differences helps clarify career paths and employer expectations in the pharmacy industry.

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Pbm Compliance jobs near you
Infographic showing various Pbm Compliance job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 84% Full Time, 11% Part Time, and 4% Contract. Highlights an 94% Physical, 2% Hybrid, and 4% Remote job distribution, with an average salary of $50,446 per year, or $24.3 per hour.

Manager - PBM/Payer Industry

Optimity Advisors

Washington, DC • On-site

Full-time

Re-posted yesterday

Job description

Company Description

Optimity Advisors is a specialized management consulting and advisory firm that focuses on strategy, operations and IT. Our company is comprised of professional advisors with deep domain expertise in strategy, operational transformation, business intelligence, technology and regulatory compliance. We combine industry expertise and integrated solutions to help companies enhance stakeholder value, improve operations, and address performance and risk-related challenges.

Job Description

PURPOSE

We are currently seeking a Manager with experience in payer systems and pharmacy benefit management (PBM). This position is ideal for a mid-level consultant that has a passion for working with clients to understand their challenges, adapt to the unique situation of the client, and develop solutions. A Manager will lead teams, drive projects, and manage relationships through all phases of the project lifecycle.

RESPONSIBILITIES

Project Delivery and Management

  • Establish and execute a common set of project management processes and tolls for a project, including but not limited to project charters, workplans, issues, risks, and change requests
  • Prepare and manage project plans and address critical issues contributing to problems or delays on a project
  • Serve as day-to-day point of contact for client resources
  • Establish and monitor key project metrics for the project
  • Provide client and Optimity management with reports, metrics, and tools to illustrate the status of the project
  • Manage the internal and external project budget
  • Drive creation of deliverables relevant to each phase of the project lifecycle and as-how analyses as needed
  • Coach to clarify assignments and deliverables; mentor others in project management practices, review quality of work, and manage the integration of team members work

NECESSARY SKILLS

  • Excellent verbal and written communication skills, including strong active listening
  • Aptitude for quick learning and subject matter expertise development
  • Highly self-motivated, detail-oriented, and able to execute in high pressure environment
  • Sound problem solving and analytical skills
  • Strong MS Suite skills including Excel, Word, PowerPoint, and Visio
Qualifications

REQUIRED QUALIFICATIONS

  • Bachelor's degree, from an accredited university or college, in Healthcare, Business, or another closely related field
  • 3 years of experience in the payer, pharmacy, or related industry
  • Experience managing projects and cross-functional teams
  • Experience with Medicaid clients
  • Experience implementing PBM systems
  • Authorization to work in the United States on a permanent basis

PREFERRED QUALIFICATIONS

  • Experience in health plan operations
  • Experience with Conduent HSP
  • Experience with PBM vendor to core systems integration
  • Experience with Managed Care Organization
  • Demonstrated career progression with increased responsibilities and mentorship
Additional Information

If you are interested in being considered for this position, please apply directly on our website using the following link:

https://optimityadvisors.bamboohr.com/jobs/view.php?id=29&source=aWQ9MjM%3D

Optimity Advisors is an EEO/AA, Veteran, and People with Disabilities employer.

Apply