Pharmacy Platform Care Management / Operations Administrator

Department: Pharmacy
Reports To: Director of Pharmacy

Pharmacy Platform Ops/System Administrator supports pharmacy operations by managing the configuration, maintenance, governance, and optimization of drug product data, pricing tables, formulary structures, system settings, user acceptance testing (UAT), and reporting within a pharmacy care management platform.

This role ensures accurate configuration of pricing logic, reimbursement rules, and product attributes that support claims processing, billing, and patient access. The position partners with pharmacy leadership, cross-functional stakeholders, and third-party technology vendors to deliver system enhancements, improve operational efficiency, and maintain data integrity.

Key Relationships

• Pharmacy Leadership
• Clinical Teams
• Finance & Contracting
• Technology Vendors
• Operations & Support Teams

Essential Responsibilities

Platform Administration

• Manage configuration and ongoing administration of the pharmacy care management platform.
• Analyze pharmacy workflows and recommend system improvements.
• Serve as a process improvement resource to streamline operational efficiency.
• Configure automated workflows, alerts, templates, and communication tools.
• Coordinate system enhancements and customization requests with external vendors.
• Lead User Acceptance Testing (UAT) for new functionality and system updates.
• Provide initial and ongoing user training.
• Troubleshoot platform issues and coordinate issue resolution.
• Gather user feedback and recommend platform enhancements.

Drug Data & Formulary Management

• Maintain drug master records and formulary information.
• Configure and validate:
  • National Drug Codes (NDCs)
  • Drug descriptions
  • Drug classifications
  • Formulary tiers
  • Coverage rules
  • Utilization management criteria
  • Pricing and cost attributes
• Maintain formulary files and data submissions.
• Coordinate updates resulting from regulatory approvals, pricing changes, and contract updates.

Pricing & Reimbursement Configuration

• Build and maintain pricing tables and reimbursement rules.
• Configure pharmacy network pricing and contract terms.
• Translate pricing strategies into system configuration.
• Support accurate claims processing through proper pricing configuration.
• Monitor pricing accuracy and investigate discrepancies.
• Resolve pricing and configuration issues.

Data Governance & Reporting

• Maintain high-quality drug master and pricing data.
• Develop data standards, templates, validation controls, and audit processes.
• Gather reporting requirements from business stakeholders.
• Prepare operational reports, dashboards, forecasts, and performance metrics.
• Analyze trends and provide recommendations for continuous improvement.

Cross-Functional Collaboration

• Represent pharmacy operations on cross-functional initiatives.
• Partner with clinical teams on formulary and coverage requirements.
• Collaborate with finance regarding reimbursement and pricing models.
• Work closely with technology vendors to deliver platform improvements.

Compliance

• Maintain confidentiality of sensitive business and patient information.
• Ensure compliance with Medicare, Medicaid, HIPAA, and applicable regulatory requirements.
• Follow all organizational policies, procedures, and quality standards.
• Maintain dependable attendance and flexibility to support operational needs.

Success Measures

• Reliable and efficient pharmacy platform operations.
• Automated workflows that improve operational efficiency.
• 99% pricing accuracy in claims processing.
• Timely product and formulary updates.
• Reduced pricing discrepancies and claim rework.
• High-quality, audit-ready drug and pricing data.
• Faster turnaround for configuration changes.
• Strong stakeholder satisfaction across pharmacy, finance, and operations.
• Accurate operational reporting and analytics.
• Effective cost management and continuous process improvement.

Required Qualifications

• Bachelor's degree in Healthcare Administration, Pharmacy, Finance, Data Analytics, Information Systems, or a related field, or equivalent experience.
• Minimum four (4) years of experience in pharmacy operations, pharmacy benefit management (PBM), healthcare analytics, reimbursement, pricing, or related healthcare operations.
• Working knowledge of pharmacy regulations and reimbursement processes.
• Strong written and verbal communication skills.
• Ability to interpret policies, procedures, and technical documentation.
• Ability to work independently in a fast-paced environment.

Preferred Qualifications

• Pharmacy Technician certification and applicable state registration.
• Experience with business process mapping and continuous improvement methodologies.
• Experience managing:
  • Drug master data
  • Formularies
  • Pricing structures
  • Claims and reimbursement systems
  • Pharmacy management platforms
• Advanced Microsoft Excel skills, including formulas, lookups, and data analysis.
• SQL experience preferred.

Core Competencies

• Pharmacy Operations
• Platform Administration
• Drug Master Data Management
• Formulary Management
• Pricing & Reimbursement
• Claims Processing
• Data Governance
• Business Analytics & Reporting
• Process Improvement
• User Acceptance Testing (UAT)
• Vendor Management
• Cross-Functional Collaboration
• Advanced Microsoft Excel
• SQL (Preferred)
• HIPAA & Regulatory Compliance