Oakland, CA, United States and 23 more

Job Description

This is a Short-Term Employment (Temporary) position which has a specified period of no more than three years of employment.

Your Role

The Pharmacy Benefits, Claims, and Network Operations team is responsible for the end-to-end operational oversight of the pharmacy benefit, ensuring members have accurate access to benefits, networks, and claims services. We lead benefit implementation and validation, manage pharmacy network operations and oversight, monitor claims and accumulator performance, support internal and external audits, and coordinate the identification, investigation, and resolution of operational incidents to protect member experience, regulatory compliance, and financial integrity.

The Project Manager, Principal will report to the Director, Pharmacy Benefits, Claims, and Network Operations. In this role you will provide end-to-end ownership of complex operational and technology initiatives, ensuring projects originating from vendor assessments, regulatory mandates, 1/1 readiness efforts, and strategic business priorities are planned, executed, and delivered successfully. This role will coordinate work across multiple vendors, IT teams, agile teams, and business stakeholders while proactively managing dependencies, risks, timelines, and communications. Given the significant technology components of many initiatives, strong technical acumen is essential to effectively translate business needs into technical requirements, challenge assumptions, assess impacts, and drive successful delivery of IT‑related solutions.

Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow – personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high‑performing teams, getting results the right way, and fostering continuous learning.

Responsibilities

Your Work

In this role, you will:

Lead complex operational and technology initiatives from intake through implementation, ensuring projects originating from vendor assessments, regulatory mandates, 1/1 readiness activities, and strategic business priorities are delivered on time and with intended outcomes.
Coordinate and influence cross‑functional teams, including operations, IT, vendors, and business stakeholders, to manage project plans, dependencies, risks, decisions, and communications across multiple concurrent work efforts.
Apply strong technical acumen to translate business objectives into actionable technical requirements, evaluate solution options, identify downstream impacts, and effectively challenge assumptions to improve delivery outcomes.
Establish and maintain project governance, including milestone tracking, issue management, executive reporting, and escalation management, to ensure accountability and timely resolution of barriers.
Drive organizational readiness by overseeing testing, implementation planning, operational transition activities, and post‑production stabilization efforts to ensure successful adoption and sustained operational performance.

Qualifications

Your Knowledge and Experience

Requires a bachelor’s degree or High School Diploma/GED and 4 years of additional relevant experience in lieu of a degree
Requires 10 years of prior relevant experience
Requires extensive experience leading complex cross‑functional programs and projects involving operations, technology, vendors, and business stakeholders, with demonstrated success delivering large‑scale initiatives from planning through implementation.
Requires proven ability to manage multiple concurrent initiatives, prioritize competing demands, identify risks and dependencies, and develop mitigation strategies in fast‑paced and highly regulated environments.
Requires deep knowledge of project management disciplines, including project planning, governance, stakeholder management, change management, issue resolution, executive communications, and resource coordination.
Requires experience working with external vendors and internal business and technology teams to drive accountability, facilitate decision‑making, and ensure successful delivery of initiatives related to operational readiness, regulatory mandates, vendor assessments, and large‑scale implementations.
Knowledge of the healthcare industry, particularly pharmacy operations, pharmacy benefit management, claims processing, formulary administration, network operations, and regulatory requirements, is strongly preferred to effectively navigate complex business and operational challenges, though not required for the role.

External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.

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