Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together.

The Pharmacy Benefits Operations Manager is a key individual contributor role that will lead the operations of Medicare Part D programs and pharmacy benefits. This role focuses on managing the Medicare Prescription Payment Plan (M3P) program, while also supporting the broader administration of prescription drug benefits, pharmacy services, regulatory compliance, and overall operational readiness.

Job Duties/Responsibilities:

Oversee day-to-day Medicare Part D pharmacy operations, including issue resolution, stakeholder coordination, CMS deliverables, and continuous process improvement.
Manage the end-to-end operations of the Medicare Prescription Payment Plan (M3P) program, including implementation oversight, member experience management, internal and external stakeholder coordination, issue resolution, and ongoing compliance monitoring to ensure alignment with CMS regulations
Support operational readiness related to annual CMS deliverables, including prescription drug benefit testing, bid submission, benefit configuration, and training on annual pharmacy benefit changes.
Contribute to the development and quality assurance of member materials, including the Annual Notice of Change (ANOC), Evidence of Coverage (EOC), pharmacy network directory, etc.
Manage regulatory compliance initiatives, including interpreting and operationalizing CMS guidance, audit preparedness, implementation of corrective actions, and tracking regulatory deliverables across internal teams, PBM, and external vendors.
Collaborate cross-functionally and with PBM and external vendors to ensure smooth operations and optimal member support
Support the development and optimization of workflows, policies, project plans, and cross-functional initiatives that align with departmental and organizational goals
Perform other duties and projects as assigned

Job Requirements:

Experience:

Required: 5 years of experience working in a health plan, PBM, IPA or managed care setting (retail pharmacy-only experience does not meet role requirements)

Preferred: 2+ years in an operations management role related to Medicare Part D highly preferred

Education:

Required: Bachelors degree in a relevant field (e.g., Healthcare Administration, Business Administration, Pharmacy, or Public Health,) or equivalent additional work experience.

Preferred: Master’s degree (MBA, MHA, MPH)

Specialized Skills:

Required:

Ability to communicate positively, professionally and effectively with others; provide leadership, teach and collaborate with others.
Effective written and oral communication skills; ability to establish and maintain a constructive relationship with diverse members, management, employees and vendors.
Attention to Detail: Ensures accuracy and compliance in all Medicare Part D documentation and processes, with a strong focus on quality control and thoroughness.
Reasoning Skills: Ability to prioritize multiple tasks; advanced problem solving; ability to use advanced reasoning to define problems, collect data, establish facts, draw valid conclusions, design, implement and manage appropriate resolution.
Problem solving Skills: Effective problem solving, organizational and time management skills and ability to work in a fast-paced environment.
Ability to work cross functionally to ensure project goals are met. Capable of adjusting project plans and strategies in response to changing circumstances and stakeholder needs.

Essential Physical Functions:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1. While performing the duties of this job, the employee is regularly required to talk or hear. The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms.

2. The employee frequently lifts and/or moves up to 10 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus.

Pay Range: $85,696.00 - $128,543.00

Pay range may be based on a number of factors including market location, education, responsibilities, experience, etc.

Alignment Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, age, protected veteran status, gender identity, or sexual orientation.

*DISCLAIMER: Please beware of recruitment phishing scams affecting Alignment Health and other employers where individuals receive fraudulent employment-related offers in exchange for money or other sensitive personal information. Please be advised that Alignment Health and its subsidiaries will never ask you for a credit card, send you a check, or ask you for any type of payment as part of consideration for employment with our company. If you feel that you have been the victim of a scam such as this, please report the incident to the Federal Trade Commission at https://reportfraud.ftc.gov/#/. If you would like to verify the legitimacy of an email sent by or on behalf of Alignment Health’s talent acquisition team, please email careers@ahcusa.com.