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Pbm Consulting Jobs in Virginia (NOW HIRING)

Elevance Health

Pharmacy Account Director

Norfolk, VA

$142K - $224K/yr

Provide ongoing consultative support to regional decision makers and partner with the PBM field sales team during renewal and RFP processes to deliver pharmacy solutions that meet client needs ...

Elevance Health

Pharmacy Account Director

Norfolk, VA · On-site

$142K - $224K/yr

Provide ongoing consultative support to regional decision makers and partner with the PBM field sales team during renewal and RFP processes to deliver pharmacy solutions that meet client needs ...

ARM Consulting

Reimbursement Specialist

Fort Belvoir, VA · On-site

$21.75 - $30/hr

PBM operations * * Specialty medication access pathways * * Copayassistanceprograms * * Patientassistanceprograms * * Reimbursement terminology * Technology Skills with: * * HUB case management ...

ARM Consulting

Reimbursement Specialist

Fort Belvoir, VA · On-site

$21.75 - $30/hr

PBM operations * * Specialty medication access pathways * * Copay assistance programs * * Patient assistance programs * * Reimbursement terminology * Technology Skills with: * * HUB case management ...

C4 Technical Services

Be Seen First

Member Services Specialist (Remote)

Richmond, VA · On-site

$18/hr

Contact center or call center experience. * Healthcare, Pharmacy Benefit Management (PBM), or ... Company Description C4 Technical Services is a forward-thinking IT, Telecom and Clinical consulting ...

New

ChenMed

Ambulatory Pharmacist

Portsmouth, VA · On-site

$118K - $168K/yr

Assists with physician consultations, provides accurate drug information, and supports the ... Experience in managed care, HMO, PBM, or MSO settings is a plus * Basic Life Support (BLS ...

ChenMed

Ambulatory Pharmacist

Portsmouth, VA · On-site

$118K - $168K/yr

Assists with physician consultations, provides accurate drug information, and supports the ... Experience in managed care, HMO, PBM, or MSO settings is a plus * Basic Life Support (BLS ...

ChenMed, LLC

Ambulatory Pharmacist

Portsmouth, VA · On-site

$118K - $168K/yr

Assists with physician consultations, provides accurate drug information, and supports the ... Experience in managed care, HMO, PBM, or MSO settings is a plus * Basic Life Support (BLS ...

All JobsPbm Consulting JobsPbm Consulting Jobs in Virginia

Pbm Consulting information

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

To thrive as a PBM (Pharmacy Benefit Management) Consultant, you need a thorough understanding of pharmacy benefits, healthcare regulations, and data analysis, often supported by a degree in pharmacy, healthcare administration, or business. Familiarity with PBM software platforms, claims processing systems, and data analytics tools is typically required. Strong communication, negotiation, and problem-solving skills distinguish top performers in this role. These skills ensure effective management of pharmacy benefits, cost optimization, and successful client relations within a complex healthcare environment.

What is PBM consulting?

PBM consulting refers to professional advisory services focused on pharmacy benefit management (PBM). Consultants in this field help health plans, employers, or other organizations optimize their pharmacy benefit programs by analyzing contracts, improving cost efficiency, ensuring regulatory compliance, and enhancing patient outcomes. They may also provide guidance on PBM selection, formulary management, and rebate negotiations. PBM consultants use industry expertise to help clients navigate the complex landscape of prescription drug benefits.

What does a Pbm Consulting do?

A PBM (Pharmacy Benefit Manager) consulting professional advises healthcare organizations on pharmacy benefit strategies, cost management, and formulary optimization. They analyze drug utilization data, develop cost-saving programs, and help implement pharmacy benefit plans to improve efficiency and compliance.

What are some common challenges faced by PBM consultants when working with clients to optimize pharmacy benefit plans?

PBM Consultants often encounter challenges such as navigating complex regulatory requirements, addressing diverse client needs, and managing tight timelines for plan implementation. They must balance cost-containment goals with ensuring access to high-quality medications and manage relationships between plan sponsors, pharmacies, and pharmaceutical manufacturers. Effective communication and staying updated on industry trends are crucial for overcoming these challenges and delivering optimal solutions for clients.
What are popular job titles related to Pbm Consulting jobs in Virginia? For Pbm Consulting jobs in Virginia, the most frequently searched job titles are:
What job categories do people searching Pbm Consulting jobs in Virginia look for? The top searched job categories for Pbm Consulting jobs in Virginia are:
What cities in Virginia are hiring for Pbm Consulting jobs? Cities in Virginia with the most Pbm Consulting job openings:
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Infographic showing various Pbm Consulting job openings in Virginia as of August 2026, with employment types broken down into 85% Full Time, 10% Part Time, and 5% Contract. Highlights an 85% Physical, 5% Hybrid, and 10% Remote job distribution.

Health & Pharmacy Analytics Lead, Human Resources

University of Virginia

Charlottesville, VA • On-site

Full-time

Medical, Dental

Re-posted 14 days ago

University Of Virginia rating

7.9

Company rating: 7.9 out of 10

Based on 35 frontline employees who took The Breakroom Quiz

207th of 616 rated colleges and universities

Job description

UVA Human Resources is seeking a Health and Pharmacy Analytics Lead to join the Benefits team . The Health and Pharmacy Analytics Lead transforms medical, pharmacy, and operational data into actionable insights that support strategic and financial decision-making for the university health plan. This role works closely with UVA's healthcare data warehouse vendor, Artemis, to develop and deliver meaningful analytics and reporting . This role leads the reporting lifecycle for cost, utilization , quality, and trend analytics; oversees dashboard and data infrastructure development; and collaborates with internal and external stakeholders, including TPAs, consultants, clinical programs, and university partners (e.g., Hoos Well, UVA Medical Center, UVA Specialty Pharmacy). Conducts claims analysis and interprets healthcare claims and coding data to support initiatives that improve member health outcomes, enhance member experience, and contribute to the long-term sustainability of the health plan.
Key Responsibilities
Analytics & Insights Development
  • Analyze medical, pharmacy, behavioral health, and vendor data to identify utilization trends, cost drivers, risk factors, and population needs.

  • Build predictive models (e.g., high - risk identification, chronic disease progression, utilization forecasting) using available plan data assets.

  • Conduct cost - of - care studies to evaluate financial impact of clinical programs, pharmacy initiatives, plan design changes, and vendor performance.

  • Utilize data ranging from claim-level detail to longitudinal trend analysis to support decision-making.

  • Explore and evaluate emerging analytics technologies, including AI-enabled tools, to enhance reporting, forecasting, data interpretation, and decision support capabilities.

Reporting & Dashboard Management
  • Develop and maintain dashboards for leadership, including KPIs related to medical spend, pharmacy spend, quality, utilization , and outcomes.

  • Produce recurring reports for executive leadership, governance committees, auditors, actuaries, and HR partners.

  • Translate complex data into clear, digestible visualizations and narratives for both technical and non - technical audiences.

Data Governance & Quality
  • Oversee data integrity, validation processes, and reconciliation across multiple sources (TPA, PBM, consultant partner, wellness partner, university systems).

  • Ensure alignment with data security, privacy, and HIPAA standards.

  • Collaborate with vendor partners to optimize data interfaces, refresh schedules, and architecture.

Cross - Functional Collaboration
  • Support Clinical Programs with actionable clinical insights (e.g., gap - in - care reports, chronic condition stratification, evaluation of interventions).

  • Partner with TPA and UVA Pharmacy leadership on drug utilization reviews, specialty trend analyses, and biosimilar opportunity modeling.

  • Partner with consultants to support forecasting, budget analysis, and actuarial activities.

Minimum Qualifications
  • Bachelor's degree or equivalent combination of related experience .

  • Certified Health Data Analyst (CHDA) credential preferred; candidates with comparable healthcare analytics experience are encouraged to apply.

  • Eight years of progressive experience in healthcare analytics, pharmacy analytics, population health, health plan operations, actuarial support, healthcare consulting, benefits analytics, or related analytical roles involving interpretation of healthcare claims, utilization , coding, and cost data to support reporting, forecasting, and decision-making.

Preferred Qualifications
  • Experience in analyzing medical and pharmacy claims data, dental claims, utilization trends, healthcare costs, and population health outcomes.

  • Working knowledge of interpreting standardized code sets that represent medical, surgical, dental and diagnostic services.

  • Demonstrated ability to translate complex healthcare, pharmacy, and operational data into actionable insights and effectively communicate findings to executive leaders, technical teams, and non-technical stakeholders.

  • Demonstrated experience developing dashboards, reports, KPIs, and executive-level analytics using Artemis by Naomi Health and/or comparable healthcare analytics platforms .

  • Strong analytical and quantitative skills, including experience with forecasting, trend analysis, predictive modeling, and financial impact analysis.

  • Demonstrated ability and willingness to leverage emerging technologies, including AI-enabled analytics and reporting tools, to improve data analysis, decision-making, and operational efficiency.

  • Experience working with healthcare data sources such as TPAs, PBMs, wellness vendors, EMRs/EHRs, or university/health system data environments.

  • Knowledge of healthcare reimbursement methodologies, claims adjudication, medical coding concepts, and pharmacy utilization management practices

  • Experience collaborating cross- functionally with leadership teams , clinical leaders, finance teams, operational stakeholders, consultants, and external vendors.

  • Knowledge of HIPAA, healthcare privacy regulations, and data governance best practices.

  • Demonstrated ability to work independently while also serving as a strategic thought partner to leadership.

This position is designated as fully remote and may be performed outside of Charlottesville, VA, in accordance with UVA's remote work guidelines. Limited travel to Charlottesville may be required on an occasional basis.
To learn more about UVA and in the Charlottesville area, visit UVA Life and Embark CVA .
This is an exempt-level, benefited position. Learn more about UVA benefits . This position is designated as restricted based on its funding sources and is subject to the continuation of available funding.
The anticipated hiring range is $ 110,000- $ 135,000 , comm ensurate with education and experience.
Application review will begin after June 26, 2026.
Background checks will be conducted on all new hires prior to employment.
How to Apply
Please apply online , by searching for requisition number R0084004 . Complete an application with the following documents:
  • Resume

  • Cover Letter

Upload all materials into the resume submission field. You can submit multiple documents into this one field or combine them into one PDF. Applications without all required documents will not receive full consideration.
Internal applicants: Apply through your Workday profile by searching "Find Jobs."
Reference checks will be completed by UVA's third-party partner, SkillSurvey, during the final phase of the interview. Five references will be requested, with at least three responses required .
For questions about the application process, please contact Ashley Cochran, alc6dk@virginia.edu .
The University of Virginia is an equal opportunity employer. All interested persons are encouraged to apply, including veterans and individuals with disabilities. Learn more about UVA's commitment to non-discrimination and equal opportunity employment .

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About University of Virginia

Sourced by ZipRecruiter

The University of Virginia is distinctive among institutions of higher education. Founded by Thomas Jefferson in 1819, the University sustains the ideal of developing, through education, leaders who are well-prepared to shape the future of the nation.

Industry

Colleges, universities, and professional schools

Company size

10,000+ Employees

Headquarters location

Charlottesville, VA, US

Year founded

1819

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