Job description
We are a healthcare technology company that provides platforms and solutions to improve the management and access of cost-effective pharmacy benefits. Our technology helps enterprise and partnership clients simplify their businesses and helps consumers save on prescriptions.
As a leader in SaaS technology for healthcare, we offer innovative solutions with integrated intelligence on a single enterprise platform that connects the pharmacy ecosystem. With our expertise and modern, modular platform, our partners use real-time data to transform their business performance and optimize their innovative models in the marketplace.
Position Summary:
The Director of Pharmacy Operations is a strategic leadership role responsible for overseeing RxSense’s pharmacy provider network strategies and operations. This role involves leading cross-functional teams, developing innovative solutions, managing critical vendors and partners, and ensuring the delivery of high-quality, competitive pharmacy services to clients. The ideal candidate will bring significant healthcare or PBM industry experience (10+ years), proven success in managing large teams, and a strategic mindset to drive process improvements, organizational growth, and business resiliency. This individual will serve as a trusted partner across the organization, influencing decision-making and driving results in a highly dynamic environment.
Essential Duties and Responsibilities :
Strategic Leadership
- Act as the primary leader for RxSense’s Pharmacy Network Operations, ensuring alignment with organizational goals, regulatory standards, and evolving client needs.
- Define and implement long-term strategies to optimize pharmacy network performance, cost efficiency, and market competitiveness.
- Establish and execute key performance indicators (KPIs) to measure provider value, network accessibility, service quality, and operational impact.
Team Leadership and Development
- Build, lead, and mentor a high-performing, cross-functional team, fostering a culture of accountability, innovation, and continuous professional development.
- Provide hands-on coaching and structured growth opportunities to support team advancement and internal talent pipelines.
Pharmacy Network & Vendor Management
- Direct the development, expansion, and optimization of RxSense’s pharmacy networks, ensuring provider diversity, geographic reach, and service excellence.
- Negotiate and manage strategic pharmacy contracts that support cost containment, quality, and member access.
- Lead all aspects of pharmacy credentialing, auditing, and URAC accreditation readiness to meet federal, state, and industry-specific standards.
- Oversee performance of key vendors and partners (e.g., fulfillment, specialty, claim processors, network partners) including SLA management, audits, and issue resolution.
Risk Management, Audit & Quality Control
- Implement robust internal controls, audit frameworks, and quality assurance programs across pharmacy operations.
- Lead proactive risk identification, root cause analysis, and remediation strategies to ensure long-term stability.
- Coordinate periodic internal and external audits, ensuring audit readiness and corrective action plans.
Client and Stakeholder Engagement
- Serve as a senior client-facing representative for RxSense, managing escalations and ensuring high-quality, solution-oriented service delivery.
- Partner with internal departments—such as Sales, Client Success, Implementation, and Compliance to support RFPs, implementations, renewals, and client strategy.
- Represent RxSense in external industry forums, associations, or regulatory working groups as needed.
Operational Excellence & Change Leadership
- Establish, document, and maintain Pharmacy Operations policies and procedures to ensure consistency, scalability, and audit readiness.
- Identify and implement process improvement initiatives, using data and analytics to drive automation, reduce risk, and enhance efficiency.
- Lead organizational transformation, process scaling, and change management efforts, ensuring smooth adoption of new systems, processes, and integrations.
- Proactively troubleshoot complex issues, lead root-cause analysis, and ensure long-term, sustainable resolution pathways are documented.
Regulatory Compliance & Policy Intelligence
- Partner with Legal and Compliance to ensure enterprise-wide compliance with applicable federal and state laws, CMS requirements, and commercial payer standards.
- Lead and maintain efforts for URAC accreditation, including documentation, policy updates, and audit preparation.
Technology & Systems Ownership
- Partner closely with Product and Technology teams to enhance pharmacy network system needs are met.
- Serve as an internal subject matter expert on operational technology, ensuring systems support scalability, compliance, and client needs.
Business Continuity & Resiliency
- Develop and maintain business continuity and disaster recovery plans for pharmacy operations, ensuring resiliency during system outages or disruptions.
- Coordinate contingency planning for provider network disruptions, data system failures, and critical operational risks.
Qualifications:
• Bachelor’s degree; advanced degree preferred (e.g., MBA, MPH, or similar), or equivalent professional experience in pharmacy benefits, healthcare, or related field
• 10+ years of relevant experience in healthcare, PBM, or pharmacy network operations.
• Proven success in leading cross-functional teams and managing large-scale projects or initiatives.
• Extensive experience in pharmacy benefits, network contracting, compliance, and provider relations.
• Strong strategic thinking and problem-solving abilities with a track record of influencing organizational outcomes.
• Experience leading teams in a matrixed environment, with a focus on mentorship and professional development.
Technical Knowledge:
• Familiarity with KPIs, analytics, and operational dashboards to measure performance.
• Knowledge of systems integrations, automation tools, and operational technologies.
*Ability to travel as needed (up to 25%)
Salary Range: $112,000 - $168,000
RxSense believes that a diverse workforce is a more talented and productive workforce. As such, we are an Equal Opportunity and Affirmative Action employer. Our recruitment process is free from discriminatory hiring practices and all qualified applicants are considered for employment without regard to race, color, religion, sex, gender, sexual orientation, gender identity, ancestry, age, or national origin. Neither will qualified applicants be discriminated against on the basis of disability or protected veteran status. We believe in the strength of the collaboration, creativity and sense of community a diverse workforce brings.
In Office Policy: Candidates within a commutable distance to one of the offices listed below will be expected to commit to a hybrid in office schedule if selected.
- Boston, MA
- Princeton, NJ
- New York City, NY
- West Palm Beach, Florida
