Manager, PBM Operations Manager

Summary

Join Rightway as the Manager of PBM Operations (Medicare) and lead operational processes for Medicare Part D, EGWP, and RDS, ensuring compliance and timely report delivery. You will serve as the operational lead and liaison with external partners, managing performance and alignment with service expectations. This role involves developing and executing CMS application processes, strengthening RDS reporting and Medicare workflows, and partnering with cross-functional teams. You will contribute to projects supporting Medicare operations scaling, monitor project milestones, analyze operational issues, and recommend process improvements. The position also includes supporting audit readiness, documentation, and quality assurance related to Medicare services. This is an opportunity to shape and strengthen Medicare operational capabilities within a fast-paced, growing organization.

Requirements

• Bachelor’s degree required; advanced degree in healthcare administration, public health, or business is a plus
• 3-5 years of experience in PBM, Medicare Part D operations, or related healthcare services
• Strong working knowledge of EGWP, RDS, and CMS application and reporting requirements
• Experience managing vendor relationships and contributing to delegated service oversight
• Demonstrated ability to work cross-functionally and lead operational projects or work-streams independently
• Excellent analytical and problem-solving skills with a track record of developing scalable solutions
• Strong written and verbal communication skills; comfortable presenting project updates and risks to leadership

Responsibilities

• Lead operational processes related to Medicare Part D, EGWP and RDS, ensuring regulatory compliance and timely delivery of required reports
• Serve as the day-to-day operational lead and liaison with external partners, monitoring performance and ensuring alignment with service expectations and operational goals
• Support and manage the development and execution of CMS application processes, including the Notice of Intent to Apply (NOIA) and bid submissions
• Strengthen and enhance RDS reporting and Medicare-related workflows by implementing structured processes and providing ongoing operational oversight
• Partner cross-functionally with Compliance, Clinical, Product, and Data teams to ensure Medicare operational needs are met and incorporated into long-term planning
• Contribute to cross-functional projects that support scaling and readiness for Medicare operations
• Monitor project milestones and provide structured updates to leadership with clear considerations, risks, and mitigation plans
• Analyze root causes of operational issues using data-driven insights and lead solution development
• Proactively recommend process improvements, automation opportunities, and operational enhancements that align with strategic objectives
• Support audit readiness, documentation development, and quality assurance related to Medicare services

Benefits

BASE SALARY: $80,000-120,000