PBM Operations Associate

ABOUT THE ROLE:

The PBM Operations Associate supports cross-functional projects across PBM operations, helping ensure strategic initiatives, audits, and internal projects move forward smoothly and stay on track. You'll work closely with teams across the organization, tracking deliverables, coordinating operational involvement, and keeping stakeholders aligned as priorities evolve. This is an execution-focused, detail-oriented role suited for someone who enjoys bringing structure to cross-functional work and can manage multiple work streams at once.

WHAT YOU’LL DO:

• Support cross-functional projects across PBM operations, including go-live management and other strategic initiatives.
• Assist with client and plan implementations, coordinating across teams to help ensure accurate benefit setup, testing, and a smooth go-live.
• Provide pre- and post-audit support, managing deliverables and tracking to ensure timely, accurate completion.
• Coordinate Ops involvement across internal projects that require operational input or support.
• Track project timelines, deliverables, and action items, flagging risks or delays as they arise.
• Maintain clear, organized documentation, including SOPs and process trackers, to support visibility across projects and teams.
• Partner with cross-functional stakeholders, including Clinical, Client Services, IT, and Compliance, to help ensure operational readiness for new initiatives and process changes.
• Support data validation and reporting tied to PBM operations projects, such as claims, eligibility, and formulary data.
• Support CMS reporting obligations, including Section 111 Medicare Secondary Payer (MSP) data submissions and Retiree Drug Subsidy (RDS) reporting, helping track deadlines, reconcile data,and resolve discrepancies.
• Identify opportunities to improve PBM operations workflows and help implement process improvements.
• Perform other duties as assigned.

WHO YOU ARE:

• Bachelor's degree or equivalent work experience.
• 2+ years of experience in PBM, pharmacy benefits, or healthcare operations preferred.
• Exposure to accreditation processes (e.g., URAC) or government programs (e.g., EGWP) is a plus, though not required.
• Familiarity with CMS regulatory reporting, such as Section 111 MSP or RDS, is a plus, though is not required.
• Strong organizational skills, with the ability to manage multiple projects and deadlines simultaneously.
• Excellent written and verbal communication skills.
• Comfortable coordinating across teams and driving progress without direct reporting authority.
• Detail-oriented with a proactive, problem-solving mindset.

EXTRA CREDIT:

• Experience supporting audits or accreditation processes.
• Experience in a fast-paced, high-growth operations environment.

COMPENSATION: $70,000-$85,000/yr

Compensation offered will be determined by geographic location, experience, and qualifications.

CYBERSECURITY AWARENESS NOTICE

In response to ongoing and industry-wide fraudulent recruitment activities (i.e., job scams), Rightway wants to inform potential candidates that we will only contact them from the @rightwayhealthcare.com email domain. We will never ask for bank details or deposits of any kind as a condition of employment. 

ABOUT RIGHTWAY:

Rightway is on a mission to harmonize healthcare for everyone, everywhere. Our products guide patients to the best care and medications by inserting clinicians and pharmacists into a patient’s care journey through a modern, mobile app. Rightway is a front door to healthcare, giving patients the tools they need along with on-demand access to Rightway health guides, human experts that answer their questions and manage the frustrating parts of healthcare for them.

Since its founding in 2017, Rightway has raised over $200mm from investors including Khosla Ventures, Thrive Capital, and Tiger Global. We’re headquartered in New York City, with satellite offices in Denver and Dallas. Our clients rely on us to transform the healthcare experience, improve outcomes for their teams, and decrease their healthcare costs.

HOW WE LIVE OUR VALUES TO OUR TEAMMATES:

We’re seeking those with passion for healthcare and relentless devotion to our goal. We need team members that embody our core values:

1) We are human, firstOur humanity binds us together. We bring the same empathetic approach to every individual we engage with, whether it be our members, our clients, or each other. We are all worthy of respect and understanding and we engage in our interactions with care and intention. We honor our stories. We listen to—and hear—each other, we celebrate our differences and similarities, we are present for each other, and we strive for mutual understanding.

2) We redefine what is possibleWe always look beyond the obstacles in front of us to imagine new solutions. We approach our work with inspiration from other industries, other leaders, and other challenges. We use ingenuity and resourcefulness when faced with tough problems.

3) We debate then commitWe believe that a spirit of open discourse is part of a healthy culture. We understand and appreciate different perspectives and we challenge our assumptions. When working toward a decision or a new solution, we actively listen to one another, approach it with a “yes, and” mentality, and assume positive intent. Once a decision is made, we align and champion it as one team.

4) We cultivate gritChanging healthcare doesn’t happen overnight. We reflect and learn from challenges and approach the future with a determination to strive for better. In the face of daunting situations, we value persistence. We embrace failure as a stepping stone to future success. On this journey, we seek to act with guts, resilience, initiative, and tenacity.

5) We seek to delightHealthcare is complicated and personal. We work tirelessly to meet the goals of our clients while also delivering the best experience to our members. We recognize that no matter the role or team, we each play a crucial part in our members’ care and take that responsibility seriously. When faced with an obstacle, we are kind, respectful, and solution-oriented in our approach. We hold ourselves accountable to our clients and our members’ success.

Rightway is proud to be an Equal Opportunity Employer that believes in the strength of diverse thought, beliefs, backgrounds, and education. We foster an inclusive culture where differences are celebrated to drive the best business decisions possible. We do not discriminate on any basis protected by applicable law. All employment decisions are based on merit, qualifications, need, and performance.