Manage onboarding, implementations, and ongoing communication to ensure alignment and strong ... Maintain a clear understanding of PBM reimbursement strategies, plan designs, MAC pricing, and ...
Manage onboarding, implementations, and ongoing communication to ensure alignment and strong ... Maintain a clear understanding of PBM reimbursement strategies, plan designs, MAC pricing, and ...
Manage onboarding, implementations, and ongoing communication to ensure alignment and strong ... Maintain a clear understanding of PBM reimbursement strategies, plan designs, MAC pricing, and ...
Manage onboarding, implementations, and ongoing communication to ensure alignment and strong ... Maintain a clear understanding of PBM reimbursement strategies, plan designs, MAC pricing, and ...
Understand and consistently utilize ProCareRx best practices for client implementations and on ... Bachelor's degree preferred * 3-5 years of experience in PBM industry, group health insurance, or ...
Understand and consistently utilize ProCareRx best practices for client implementations and on ... Bachelor's degree preferred * 3-5 years of experience in PBM industry, group health insurance, or ...
Understand and consistently utilize ProCareRx best practices for client implementations and on ... Bachelor's degree preferred * 3-5 years of experience in PBM industry, group health insurance, or ...
Quick apply
Understand and consistently utilize ProCareRx best practices for client implementations and on ... Bachelor's degree preferred * 3-5 years of experience in PBM industry, group health insurance, or ...
Understand and consistently utilize ProCareRx best practices for client implementations and on ... Bachelor's degree preferred * 3-5 years of experience in PBM industry, group health insurance, or ...
Understand and consistently utilize ProCareRx best practices for client implementations and on ... Bachelor's degree preferred * 3-5 years of experience in PBM industry, group health insurance, or ...
... PBM) setting. Partner cross-functionally with Underwriting, Finance, Clinical, and Account ... Executing weekly pricing tasks to ensure accuracy and implementation consistency. * Gathering and ...
... PBM) setting. Partner cross-functionally with Underwriting, Finance, Clinical, and Account ... Executing weekly pricing tasks to ensure accuracy and implementation consistency. * Gathering and ...
... PBM) setting. Partner cross-functionally with Underwriting, Finance, Clinical, and Account ... Executing weekly pricing tasks to ensure accuracy and implementation consistency. * Gathering and ...
New
... PBM) setting. Partner cross-functionally with Underwriting, Finance, Clinical, and Account ... Executing weekly pricing tasks to ensure accuracy and implementation consistency. * Gathering and ...
New
... PBM) setting. Partner cross-functionally with Underwriting, Finance, Clinical, and Account ... Executing weekly pricing tasks to ensure accuracy and implementation consistency. * Gathering and ...
... PBM) setting. Partner cross-functionally with Underwriting, Finance, Clinical, and Account ... Executing weekly pricing tasks to ensure accuracy and implementation consistency. * Gathering and ...
... PBM) setting. Partner cross-functionally with Underwriting, Finance, Clinical, and Account ... Executing weekly pricing tasks to ensure accuracy and implementation consistency. * Gathering and ...
... PBM) setting. Partner cross-functionally with Underwriting, Finance, Clinical, and Account ... Executing weekly pricing tasks to ensure accuracy and implementation consistency. * Gathering and ...
... PBM) setting. Partner cross-functionally with Underwriting, Finance, Clinical, and Account ... Executing weekly pricing tasks to ensure accuracy and implementation consistency. * Gathering and ...
... PBM) setting. Partner cross-functionally with Underwriting, Finance, Clinical, and Account ... Executing weekly pricing tasks to ensure accuracy and implementation consistency. * Gathering and ...
... PBM) setting. Partner cross-functionally with Underwriting, Finance, Clinical, and Account ... Executing weekly pricing tasks to ensure accuracy and implementation consistency. * Gathering and ...
New
... PBM) setting. Partner cross-functionally with Underwriting, Finance, Clinical, and Account ... Executing weekly pricing tasks to ensure accuracy and implementation consistency. * Gathering and ...
New
... PBM) setting. Partner cross-functionally with Underwriting, Finance, Clinical, and Account ... Executing weekly pricing tasks to ensure accuracy and implementation consistency. * Gathering and ...
New
... PBM) setting. Partner cross-functionally with Underwriting, Finance, Clinical, and Account ... Executing weekly pricing tasks to ensure accuracy and implementation consistency. * Gathering and ...
New
... PBM) setting. Partner cross-functionally with Underwriting, Finance, Clinical, and Account ... Executing weekly pricing tasks to ensure accuracy and implementation consistency. * Gathering and ...
New
... PBM) setting. Partner cross-functionally with Underwriting, Finance, Clinical, and Account ... Executing weekly pricing tasks to ensure accuracy and implementation consistency. * Gathering and ...
New
... PBM) setting. Partner cross-functionally with Underwriting, Finance, Clinical, and Account ... Executing weekly pricing tasks to ensure accuracy and implementation consistency. * Gathering and ...
... PBM) setting. Partner cross-functionally with Underwriting, Finance, Clinical, and Account ... Executing weekly pricing tasks to ensure accuracy and implementation consistency. * Gathering and ...
... PBM) setting. Partner cross-functionally with Underwriting, Finance, Clinical, and Account ... Executing weekly pricing tasks to ensure accuracy and implementation consistency. * Gathering and ...
... PBM) setting. Partner cross-functionally with Underwriting, Finance, Clinical, and Account ... Executing weekly pricing tasks to ensure accuracy and implementation consistency. * Gathering and ...
... PBM) setting. Partner cross-functionally with Underwriting, Finance, Clinical, and Account ... Executing weekly pricing tasks to ensure accuracy and implementation consistency. * Gathering and ...
... PBM) setting. Partner cross-functionally with Underwriting, Finance, Clinical, and Account ... Executing weekly pricing tasks to ensure accuracy and implementation consistency. * Gathering and ...
... PBM) setting. Partner cross-functionally with Underwriting, Finance, Clinical, and Account ... Executing weekly pricing tasks to ensure accuracy and implementation consistency. * Gathering and ...
... PBM) setting. Partner cross-functionally with Underwriting, Finance, Clinical, and Account ... Executing weekly pricing tasks to ensure accuracy and implementation consistency. * Gathering and ...
... PBM) setting. Partner cross-functionally with Underwriting, Finance, Clinical, and Account ... Executing weekly pricing tasks to ensure accuracy and implementation consistency. * Gathering and ...
... PBM) setting. Partner cross-functionally with Underwriting, Finance, Clinical, and Account ... Executing weekly pricing tasks to ensure accuracy and implementation consistency. * Gathering and ...
... PBM) setting. Partner cross-functionally with Underwriting, Finance, Clinical, and Account ... Executing weekly pricing tasks to ensure accuracy and implementation consistency. * Gathering and ...
... PBM) setting. Partner cross-functionally with Underwriting, Finance, Clinical, and Account ... Executing weekly pricing tasks to ensure accuracy and implementation consistency. * Gathering and ...
... PBM) setting. Partner cross-functionally with Underwriting, Finance, Clinical, and Account ... Executing weekly pricing tasks to ensure accuracy and implementation consistency. * Gathering and ...
... PBM) setting. Partner cross-functionally with Underwriting, Finance, Clinical, and Account ... Executing weekly pricing tasks to ensure accuracy and implementation consistency. * Gathering and ...
Pbm Implementation information
What are the key skills and qualifications needed to thrive as a PBM Implementation Specialist, and why are they important?
To thrive as a PBM Implementation Specialist, you need a solid understanding of pharmacy benefit management, project management skills, and familiarity with healthcare regulations, often supported by a relevant bachelor’s degree. Experience with PBM software platforms, data integration tools, and possibly certifications like PMP are highly valued. Outstanding problem-solving, attention to detail, and strong communication skills set top performers apart in this role. These skills are essential for ensuring seamless implementation of PBM solutions, minimizing errors, and maintaining compliance in a complex, regulated environment.
What is a PBM Implementation specialist?
A PBM Implementation specialist is a professional who manages and oversees the process of integrating pharmacy benefit management (PBM) services for clients, such as health plans or employers. Their role involves coordinating system setups, benefit configurations, and data transfers to ensure accurate and efficient delivery of prescription drug benefits. They work closely with internal teams and clients to understand requirements, resolve issues, and ensure a smooth transition to PBM services. Strong communication, project management, and technical skills are essential in this role.
What are some common challenges faced during PBM implementation projects, and how can they be addressed?
One of the main challenges in PBM (Pharmacy Benefit Management) implementation is coordinating between multiple stakeholders, such as clients, vendors, and internal IT teams, to ensure accurate data integration and system configuration. This role often requires managing tight deadlines and rapidly resolving issues that arise during system testing and member migration. To address these challenges, strong project management skills, clear communication, and a proactive approach to identifying potential risks are essential. Collaboration with cross-functional teams and maintaining detailed documentation can also help ensure a smooth implementation process.
What is the difference between Pbm Implementation vs Pbm Analyst?
| Aspect | Pbm Implementation | Pbm Analyst |
|---|---|---|
| Credentials | Relevant certifications, technical skills | Same certifications, analytical skills |
| Work Environment | Project-based, cross-functional teams | Data analysis, reporting focus |
| Industry Usage | Healthcare, pharmacy benefit management | Healthcare, insurance, benefits analysis |
| Primary Focus | Implementing PBM systems and processes | Analyzing data, generating insights |
While both roles require similar credentials and operate within the healthcare and PBM industry, Pbm Implementation focuses on deploying and configuring PBM systems, whereas Pbm Analysts analyze data to optimize benefits and costs. The implementation role is more project-oriented, while analysts focus on data insights.
What are popular job titles related to Pbm Implementation jobs in Michigan? For Pbm Implementation jobs in Michigan, the most frequently searched job titles are:
What job categories do people searching Pbm Implementation jobs in Michigan look for? The top searched job categories for Pbm Implementation jobs in Michigan are:
What cities in Michigan are hiring for Pbm Implementation jobs? Cities in Michigan with the most Pbm Implementation job openings:
Full-time
Medical, Dental, Vision, Life, Retirement, PTO
Posted 6 days ago
Insight Enterprises rating
8.5
Based on 19 frontline employees who took The Breakroom Quiz
30th of 210 rated it services
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:
Key Responsibilities:
PBM Partnership Management
Self-Funded Employer Network Development
Payer & Network Growth
Operational & Contract Coordination
Performance Monitoring & Reporting
Relationship Building & Strategic Development
Required Qualifications
Preferred Qualifications
Insight is an equal opportunity employer and values workplace diversity!
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!
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