SVP, Core PBM Operations

Magellan Health Services   •  

Scottsdale, AZ

Industry: Healthcare


11 - 15 years

Posted 92 days ago

This job is no longer available.


Reporting to the MRx COO, the SVP Core PBM Operations will be responsible for leading key functions supporting Magellan Rx Management’s pharmacy benefits management business, including but not limited to benefit plan administration, eligibility, card production, paper claims, claims adjudication, and the associated systems on which these functions reside. In addition to developing and maintaining a corresponding core PBM Operations strategy, this leader is also responsible for defining appropriate service levels and performance guarantees, and managing operations outcomes to meet or exceed those standards. The SVP will also represent MRx externally in industry organizations such as NCPDP and partner with MRx IT to ensure compliance with the related claims standards. This role is intended to be part of the succession plan for the MRx Chief Operating Officer role.
This role supports all lines of business at MRx, including fee for service, employer, MCO, Exchange and Medicare Part D. It includes enabling customer implementations, defining and driving implementation of regulatory and client-driven enhancements, and anticipating market demand for associated Core & Claims Operations services. Additionally, the head of Core PBM Operations also is responsible for defining and driving productivity and quality enhancements, making it easier and less costly for internal stakeholders, clients and regulators to do business with MRx. And finally, the leader is responsible for providing business and functional requirements, as well as product ownership, for approximately 10 application systems, while concurrently managing related process monitoring and surveillance.
More specifically, the SVP Core PBM Operations is also responsible for:
- Leading development of a multi-year core systems strategy for MRx, partnering with MRx IT and other key business units, designed to enable achievement of our overall strategic goals
- Executing the core systems strategy, achieving intended business outcomes
- Developing internal operations solutions with a customer-focused orientation
- Own key vendor relationships including claims adjudication engines, electronic prescribing, drug compendia information, including negotiating vendor contracts, overseeing execution and managing issues
- Transitioning vendor-provided and –managed services to internal, scalable operations for claims processing, when appropriate
- Overseeing benefit design and configuration including standard and custom options along with formulary configuration, eligibility and card production
- Supporting customer implementations including client customizations
- Enabling new product and program development, working together with MRx Product and other teams
- Monitoring new regulatory initiatives and requirements including Federal, DOI, State, and NCPDP changes, driving the necessary process and technology changes needed to achieve compliance with those standards
- Partnering with the MRx Software Quality Assurance and other quality teams to respond to identified issues, driving resolution and prevention
- Interfacing with other key MRx and vendor areas including Clinical, Information Technology, Networks, Finance, Business Development, Customer Service and others
- Functioning as a member of the senior Operations leadership team with respect to providing creative solutions, proposing new opportunities and driving toward an aggressive growth target
Essential Functions:
- Partner with IT, Trade Relations, Clinical, Product and Business Development leadership teams to define business requirements for all operational support systems
- Create and/or define processes, tools, measurements and systems consistent with processes found in SBU environment
- Determine areas of overlap and opportunities for synergies with SBU business by working with all subject matter experts to ensure operational effectiveness
- Develop financial operating model in partnership with Finance team and execute to annual budget target, driving year-over-year improvements in productivity
- Establish strategic objectives; implement, monitor, measure and refine objectives to ensure positive outcomes and alignment with corporate performance goals
- Manage staff and help develop them to meetretention,diversityand other goals

General Job Information



SVP, PBM Operations



Job Family

Pharmacy Group


United States of America

FLSA Status

United States of America (Exempt)

Recruiting Start Date


Date Requisition Created


Minimum Qualifications



License and Certifications - Required

License and Certifications - Preferred

LSSBB - Lean Six Sigma Black Belt Certification - Enterprise

Other Job Requirements


10+yearexperience working in a healthcare and/or PBM operations capacity.Medicare and Medicaidexperiencehighly desirable. Proven leader of senior leaders. Experience from within an exponential growth organization.Deep domain expertise in all aspects of PBM operations in an executive leadership capacity.