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Pbm Manager information

What is a PBM manager?

A PBM Manager, or Pharmacy Benefit Manager Manager, is a professional responsible for overseeing the relationship between healthcare providers, insurance companies, and pharmacy benefit management companies. They work to ensure that prescription drug benefits are managed efficiently, negotiate contracts, and monitor compliance with regulations. PBM Managers analyze drug utilization data, manage formularies, and help control drug costs while ensuring patients have access to necessary medications. Their role is crucial in optimizing pharmacy benefit programs for employers, health plans, and other organizations.

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

To thrive as a PBM (Pharmacy Benefit Manager) Manager, you need a strong background in pharmacy operations, healthcare management, and a bachelor's degree in pharmacy, healthcare administration, or a related field. Familiarity with pharmacy benefit management systems, claims processing software, and regulatory compliance tools is crucial. Strong analytical skills, leadership, and effective communication are vital soft skills for collaborating with clients, vendors, and internal teams. These competencies are essential to optimize drug benefit programs, ensure regulatory compliance, and deliver value-driven healthcare solutions.

What are some common challenges PBM managers face when coordinating between pharmacies, insurers, and healthcare providers?

PBM Managers often encounter challenges related to balancing the interests of various stakeholders, such as negotiating contracts and ensuring formulary compliance while maintaining cost-effectiveness and patient satisfaction. They must navigate complex regulatory requirements and address discrepancies in drug pricing or reimbursement. Effective communication and problem-solving skills are essential, as the role frequently involves resolving issues that arise from claim disputes, prior authorization processes, and network management. Collaboration with cross-functional teams is key to streamlining operations and optimizing outcomes for all parties involved.

What is the difference between Pbm Manager vs Pbm Analyst?

AspectPbm ManagerPbm Analyst
CredentialsBachelor's degree, certifications like CPhT or PMP often preferredBachelor's degree, certifications like CPhT or relevant industry certifications
Work EnvironmentOversees teams, manages projects, strategic planningAnalyzes data, supports decision-making, reports generation
Employer & Industry UsagePharmacy benefit management companies, healthcare providersPharmacy benefit management companies, healthcare organizations

The Pbm Manager typically handles team leadership, strategic planning, and project management within pharmacy benefit management. In contrast, the Pbm Analyst focuses on data analysis, reporting, and supporting decision-making processes. Both roles require relevant certifications and work within similar healthcare environments, but the Manager has a broader leadership scope while the Analyst specializes in data-driven tasks.

What are the most commonly searched types of Pbm jobs in Rio Rancho, NM?

The most popular types of Pbm jobs in Rio Rancho, NM are:

What job categories do people searching Pbm Manager jobs in Rio Rancho, NM look for?

The top searched job categories for Pbm Manager jobs in Rio Rancho, NM are:

What cities near Rio Rancho, NM are hiring for Pbm Manager jobs?

Cities near Rio Rancho, NM with the most Pbm Manager job openings:

Pbm Manager jobs near you
Infographic showing various Pbm Manager job openings in Rio Rancho, NM as of August 2026, with employment types broken down into 85% Full Time, 13% Part Time, and 2% Contract. Highlights an 83% Physical, 2% Hybrid, and 15% Remote job distribution.

Client Audit Specialist (PBM) - Remote

Prime Therapeutics LLC

Albuquerque, NM • On-site, Remote

Full-time

Posted 17 days ago

Key responsibilities

  • Manage regulatory and/or client-initiated audits by evaluating audit requests, determining scope, and managing end-to-end audit activities.

  • Develop and maintain relationships with internal and external stakeholders to provide audit consultation, ensure timely completion, and communicate audit results.

  • Monitor audit progress, identify and mitigate risks, perform quality reviews of audit deliverables, and prepare documentation for audit activities.

Prime Therapeutics rating

7.9

Company rating: 7.9 out of 10

Based on 48 frontline employees who took The Breakroom Quiz

16th of 113 rated pharmacies

Job description

At Prime Therapeutics (Prime), we are a different kind of PBM, with a purpose beyond profits and a unique ability to connect care for those we serve. Looking for a purpose-driven career? Come build the future of pharmacy with us.
Job Posting Title
Client Audit Specialist (PBM) - RemoteJob Description
As a member of the Client Audit Management (CAM) team, the Client Audit Specialist is accountable for independently, or in collaboration with senior staff or compliance leader, managing regulatory and/or client-initiated audits. The Specialist is responsible for evaluating and understanding the purpose of various audit types and the related deliverables, developing a holistic understanding of the audit management process, and managing the end-to-end audit activities. This position seeks and obtains additional expertise as indicated from respective Compliance and Operational subject matter experts to meet applicable regulatory, client, and/or functional audit expectations.
Responsibilities
  • Review and interpret assigned audit requests to determine scope, impacted business areas and stakeholders, and evidence necessary to fulfill and manage the audit request
  • Present sample cases or evidence data for assigned processes and act as a subject matter expert for business requirements, system specification, process flows, process change, Federal and/or State regulations and/or accreditation standards implications
  • Develop and maintain key internal and external stakeholder relationships to effectively provide audit consultation, streamline work activity, create/drive efficiencies, and ensure consistent, timely, and accurate audit completion, reporting, or submission of deliverables
  • Monitor audit progress and proactively identify and mitigate risks (including performance guarantee implications) to audit completion; appropriately escalate to Audit Advisors, department leadership or operational stakeholders and provide remediation recommendations to prevent delays or future findings
  • Perform quality reviews and analysis of audit deliverables to ensure compliance with contractual and regulatory requirements
  • Ensure stakeholders have a thorough understanding of their audit-related responsibilities, are accountable to producing deliverables accurately and on time, and are informed of relevant audit status updates or changes
  • Ensure thorough audit records are developed and maintained, with emphasis on accuracy, relevance, and timeliness; prepare necessary documentation for audit activities including deliverables, reports, findings and recommendations; provide clear and concise audit result communications to internal and external stakeholders
  • Integrate project management and organization capabilities by effectively communicating and leading audit strategy, deliverables, requirements, milestones and accountability, throughout the entire audit
  • Support department enhancement initiatives to ensure accurate and thorough training and procedural materials are available and maintained
  • Other duties as assigned

Minimum Qualifications
  • Bachelor's degree in Business, Health Care Services or related area of study, or equivalent combination of education and/or relevant work experience; HS diploma from an accredited school or equivalent GED is required
  • 2 years of relevant work experience in audit, compliance or operations within a regulated environment

Must be eligible to work in the United States without the need for work visa or residency sponsorship
Additional Qualifications
  • Effective verbal and written communication, and presentation skills; ability to effectively distill complex information into clear and compelling presentations and leadership briefings
  • Strong interpersonal skills, with the ability to effectively facilitate meetings, resolve conflict, build consensus, establish rapport and collaborate effectively across departments, internally and externally, and at all levels within an organization; ability to confidently represent the business and interact with external entities
  • Demonstrated critical thinking and analysis skills, with proven ability to navigate ambiguous, complex and challenging situations while maintaining professionalism, tact, and empathy
  • Organization and prioritization skills, strong attention to detail, and the ability to simultaneously manage multiple, complex projects, under pressure and strict timeframes, without compromising quality
  • Agility and adaptability to change and navigate in a demanding, dynamic, fast-paced, intense, and matrix environment
  • Ability to use independent judgment and critical decision making in the analysis of audit processes and evidence
  • Intermediate to Advanced skills in Microsoft Office Suite (Word, Excel)

Preferred Qualifications
  • Health insurance/PBM operations and/or contract audit experience
  • Experience with regulatory compliance for Medicare/Medicaid/Commercial or ACA drug benefit
  • Project management experience

Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their job, and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures
Every employee must be able to perform the essential functions of the job and, if requested, reasonable accommodations will be made to enable employees with disabilities to perform the essential functions, absent undue hardship. In addition, Prime retains the right to change or assign other duties to this job.
Potential pay for this position ranges from $66,000.00 - $106,000.00 based on experience and skills.
To review our Benefits, Incentives and Additional Compensation, visit our Benefits Page and click on the "Benefits at a glance" button for more detail (https://www.primetherapeutics.com/benefits).
Prime Therapeutics LLC is proud to be an equal opportunity and affirmative action employer. We encourage diverse candidates to apply, and all qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sex (including pregnancy), national origin, disability, age, veteran status, or any other legally protected class under federal, state, or local law.
We welcome people of different backgrounds, experiences, abilities, and perspectives including qualified applicants with arrest and conviction records and any qualified applicants requiring reasonable accommodations in accordance with the law.
Prime Therapeutics LLC is a Tobacco-Free Workplace employer.
Positions will be posted for a minimum of five consecutive workdays.

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About Prime Therapeutics

Sourced by ZipRecruiter

Prime Therapeutics, located in Eagan, MN, is a pharmacy benefits management company that has been serving the healthcare industry since its foundation. They are an integral participant in the medical sector, specifically in the realm of health insurance. They focus on providing innovative pharmacy benefits and services to more than 30 million members nationwide. Besides their main pharmacy benefit management, they offer mail service pharmacy, specialty pharmacy, benefits management, and consultative engagement services to ensure individuals have continuous access to affordable prescription drugs. Prime Therapeutics, founded around three decades ago, has grown to stand out as a leader in its industry, thanks to its commitment to improving the health of its clients.

Industry

Insurance services

Company size

1,001 - 5,000 Employees

Headquarters location

Eagan, MN, US

Year founded

1987

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