Manager, PBM Operations Manager (Medicare)

ABOUT THE ROLE:

As the Manager of PBM Operations (Medicare), you will serve as the operational lead for our Medicare line of business, supporting our Employer Group Waiver Plan (EGWP), Medicare Part D, and Retiree Drug Subsidy (RDS) offerings. This role will be responsible for building and overseeing operational workflows that ensure compliance with CMS regulations, supporting internal teams and external partners to deliver Medicare services effectively. This is an opportunity to shape and strengthen our Medicare operational capabilities, contribute to strategic initiatives, and operate with a high level of ownership in a fast-paced, growing organization.

WHAT YOU’LL DO:

• 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

WHO YOU ARE:

• 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

BASE SALARY: $80,000-120,000

Offer amounts for both remote and in office roles are influenced by geographic location.

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 $205mm from investors including Khosla Ventures, Thrive Capital, and Tiger Global. We’re headquartered in New York City, with a satellite office in Denver. 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 following core values:

1) We are human, first
Our 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 possible
We 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 commit
We 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 grit
Changing 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 delight
Healthcare 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 Proudly an Equal Opportunity Employer that believes in strength in the diversity of thought processes, beliefs, background and education and fosters an inclusive culture where differences are celebrated to drive the best business decisions possible. We do not discriminate on any basis covered by appropriate law. All employment is decided on the consideration of merit, qualifications, need and performance.