Provide support for Clinical Innovation and Operations teams. Assist in configuration and analysis of benefits, formulary, and utilization management. Research insurance benefit details for commercial, exchange, Medicare, and Medicaid payers. Present registration documents to regulatory agencies and carry out negotiations necessary to obtain or maintain authorization for the services concerned. Follow all internal policies & procedures to ensure consistency, accuracy, and operational effectiveness. Supervise workstreams and interact with health plan clients’ operations teams on a regular basis to address outstanding issues and bring them to resolution. Work closely with diverse departments to manage and drive daily clinical operations and projects within schedule, scope, and quality to meet established service level agreements. Monitor and review state and federal healthcare polices to ensure that the platform is compliant. Assist in monitoring and training new hires/offshore team in several areas of the platform to enhance the team’s expertise. Report issues/suggestions for improvement to the product team or reach out to client for resolution if necessary. Attend client meetings for requirements gathering, communicate to product team and validate once in production. Provide support for Clinical Programs including support for formulary development and developing/supporting specialty programs. Effectively coordinate with members, pharmacy personnel, healthcare providers and internal staff for issues and work towards resolutions. Oversee daily clinical activities of the offshore team, perform validations, and interact with the client for operational efficiency. Communicate with vendors in order to facilitate new projects, implementations, and operational duties. Perform in compliance with the current PBM v2.2 URAC standards applicable to the position. Bachelor's degree plus college-level coursework required. Worksite: Southborough, MA. Send resume using Reference Code 3231 to: