Pharmacy Operations Vendor Manager
California
Imperial Health Holdings
Reports To: Manager, Pharmacy Services
About the Role
Imperial Health Holdings is seeking a highly organized, operations-focused Pharmacy Operations Vendor Manager to serve as the primary liaison between the health plan, PBMs, vendors, internal teams, and provider groups.
This role leads PBM implementation and transition efforts from planning through go-live and stabilization, including but not limited to project timelines, operational readiness, regulatory coordination, testing oversight, issue resolution, and stakeholder communication.
Following implementation, this role oversees ongoing PBM and vendor operations, including but not limited to performance monitoring, operational issue resolution, compliance coordination, and vendor management across Medicare Advantage, Medicare Part D, and Exchange lines of business. This role functions as the central operational coordinator for pharmacy implementations and ongoing vendor operations, ensuring cross-functional alignment, accountability, and execution across internal and external stakeholders.
Key Responsibilities
PBM Implementation & Transition
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Lead PBM implementation and transition activities end-to-end, including but not limited to planning, execution, testing coordination, and go-live readiness
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Coordinate PBM, vendors, internal teams, and leadership across all workstreams, including but not limited to operations, IT, compliance, finance, and member services
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Own project plans, timelines, milestones, dependencies, and implementation tracking
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Run implementation meetings, track action items, and ensure completion of deliverables
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Oversee testing coordination including but not limited to claims, eligibility, prior authorization workflows, formulary setup, CMS files, COB, accumulators, and communications testing
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Ensure benefit configuration and operational workflows align with CMS, state, and health plan requirements
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Identify operational risks, gaps, and escalation issues, including but not limited to system, vendor, and process issues
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Support go-live readiness and post-go-live stabilization activities
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Maintain issue logs, decision tracking, documentation, and status reporting
Project & Cross-Functional Coordination
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Manage multiple pharmacy operational projects, including but not limited to implementations, vendor initiatives, regulatory projects, and system enhancements
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Coordinate internal pharmacy operational priorities across departments to ensure alignment, readiness, and timely execution
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Track internal deliverables, dependencies, and operational readiness activities
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Maintain project trackers, timelines, dashboards, and executive reporting
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Ensure accountability across internal teams and external vendors
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Identify process improvement opportunities, including but not limited to workflow standardization and operational efficiency improvements
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Support development and maintenance of operational policies, procedures, and workflows
PBM & Vendor Operations Oversight
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Monitor PBM and vendor performance, including but not limited to service levels, turnaround times, and operational execution
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Lead recurring operational and vendor meetings, including but not limited to PBM, pharmacy vendors, and internal stakeholders
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Track and resolve operational issues including but not limited to claims processing, eligibility, prior authorization workflow issues, formulary updates, and network-related issues
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Support vendor oversight activities, including but not limited to audits, corrective action plans, and performance reviews
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Drive operational improvements, efficiency initiatives, and workflow optimization across vendors and internal teams
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Ensure operational compliance with CMS, Medicare Part D, HPMS, NCQA, and state requirements, including but not limited to regulatory updates and reporting obligations
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Track and manage regulatory deliverables and deadlines, including but not limited to CMS submissions, reporting (e.g. Acumen), and audit requirements
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Support operational coordination for CMS processes including but not limited to PDE file management, MTM operations support, appeals processing, and utilization management workflows
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Coordinate formulary updates, AEP/OEP readiness, and annual operational cycles
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Assist with audit support, documentation, and corrective action tracking
Provider Group (IPA) Operational Coordination
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Serve as primary operational liaison with IPA/provider groups on pharmacy-related administrative and operational initiatives, including but not limited to performance tracking, issue resolution, and process coordination
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Lead recurring meetings with provider groups, including but not limited to operational reviews, service issues, and performance updates
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Translate provider feedback into actionable operational follow-up with internal teams
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Support improvement of operational pharmacy metrics including but not limited to:
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Medication adherence program tracking
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Pharmacy quality and operational performance coordination
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Pharmacy operational performance reporting and administrative metric tracking
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Administrative quality performance measures
Cross-Functional Collaboration
Partner with Compliance, IT, Claims, Finance, Member Services, Provider Relations, Delegation Oversight, and Analytics teams to support PBM operations, implementations, regulatory requirements, and ongoing vendor management activities, including but not limited to system changes, reporting needs, and operational enhancements.
Qualifications
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Bachelor’s degree preferred in Healthcare Administration, Business, Public Health, or related field
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5–7+ years of experience in managed care, PBM operations, vendor management, or Medicare Advantage operations
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Strong understanding of Medicare Part D operational and CMS regulatory requirements
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Experience with PBM implementations, transitions, or vendor oversight
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Strong project management skills, including but not limited to managing multiple priorities and deadlines
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Strong communication and stakeholder coordination skills
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Ability to work independently and drive operational initiatives to completion
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Proficiency in Microsoft Office Suite including but not limited to Excel, Word, PowerPoint, Outlook, and Teams
Additional Duties as Needed
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Handle other operational work as assigned, including urgent PBM issues, escalations, system or vendor disruptions, regulatory requests, and other time-sensitive needs
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Support leadership with ad hoc requests, analysis, reporting, and coordination to keep pharmacy operations running smoothly
Preferred Experience
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Medicare Advantage and/or Exchange operational experience
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CMS audit or regulatory operations experience
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Vendor management or PBM oversight experience
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IPA/provider group operational coordination experience
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Claims, eligibility, or utilization management operations experience
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Pharmacy benefit operations, reporting, or system configuration experience
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PBM transition or implementation experience
Work Environment
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Office-based role unless remote work is approved
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Responsibilities may include but are not limited to after-hours support during implementations, go-lives, audits, or regulatory deadlines
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Occasional travel may be required, including but not limited to vendor, PBM, or provider group meetings
