The Implementation Manager is responsible for overseeing and coordinating all aspects of client implementations for pharmacy benefit management (PBM) services. This role ensures a seamless onboarding process for new clients and successful execution of benefit plan setups, formulary configurations, system integrations, and operational readiness across internal and external stakeholders.
Role and Responsibilities- Client Onboarding:
- Serve as the primary point of contact for new client implementations.
- Lead kickoff meetings and set expectations for the implementation timeline, deliverables, and milestones.
- Manage and document client requirements, ensuring accurate translation into internal systems.
- Manage member communication and outreach activities associated with implementation and transition events
- Interpret and accurately translate benefit plans, formulary requirements, coverage rules, and client-selected program offerings into operational and system requirements.
- Support post-go-live audits, stabilization efforts, and continuous improvement initiatives
- Lead implementation-to-account-management transition activities, ensuring all documentation, decisions, and open items are appropriately transferred.
- Project Management:
- Develop detailed project plans, monitor progress, and ensure deadlines are met.
- Coordinate across cross-functional teams (e.g., IT, Clinical, Operations, Compliance, and Account Management) to ensure alignment and execution.
- Identify risks and develop mitigation plans to address potential delays or issues.
- Coordinate collection and analysis of historical claims, eligibility, accumulator, and utilization data required for implementation planning and transition activities.
- Documentation and Testing:
- Document benefit plan setup, formulary requirements, network requirements and other components of claims adjudication
- Coordinate eligibility, accumulator and claim file integration.
- Ensure that testing and validation is completed and communicate testing results back to clients
- Ensure clean handoff to operations and account management teams post go-live.
- Client Communication and Reporting:
- Provide regular status updates and documentation to clients and internal leadership.
- Facilitate meetings, maintain action item logs, and ensure resolution of client concerns during the implementation phase.
- Process Improvement:
- Participate in post-implementation reviews to assess performance and identify opportunities for continuous improvement.
- Contribute to the development of implementation playbooks, templates, and SOPs.
Qualifications and Education Requirements- Bachelor's degree in business, Healthcare Administration, Pharmacy, or a related field. Equivalent combination of education and experience may be considered in lieu of a degree.
- 3-5 years of experience in PBM, healthcare, or benefit administration, with a minimum of 2 years' experience in client implementation or project management.
- Strong understanding of PBM operations including benefit design, formulary management, claims processing, and eligibility.
- Proficiency in Microsoft Office Suite; experience with project management tools (e.g., MS Project, Smartsheet, Jira).
- Excellent communication, organizational, and leadership skills.
- Ability to manage multiple complex projects simultaneously and work effectively under pressure, with internal and external stakeholders.
Preferences- PMP certification or equivalent project management experience (preferred).
- Prior experience within the PBM industry.
- Demonstrated ability to manage complex workflows in a dynamic environment.
- Strong problem-solving skills and a proactive mindset.
- Commitment to learning, adaptability, and continuous improvement.
Physical RequirementsThe physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.
This is a largely sedentary role; however, some standing, walking, bending, and reaching may be required. Regularly operates in an office or home office setting which involves utilizing a computer, mouse, keyboard, and occasionally operates other standard office equipment, such as printer, copier, phone. Travel may be required by either car or airplane, or a combination of multiple modes of transportation.
