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Advanced Technologies. Powerful Results.
Product Manager, Pharma CoPay Programs – Client Organization Model Administration
Location
United States
Posted
79 days ago
Salary
$100K - $149K / year
Seniority
Senior
Job Description
Product Manager, Pharma CoPay Programs – Client Organization Model Administration
RxSense
• The Product Manager owns the strategy, roadmap, and delivery of core healthcare benefit solutions, including Coordination of Benefits (COB), Pharma Copay programs, Client Organization Model Administration (Hierarchy), the Member Portal experience, and high-level Benefit Administration Portal navigation. • This role is responsible for defining and executing a product vision that delivers measurable value to payers, PBMs, pharmacies, manufacturers, and ultimately patients—balancing regulatory requirements, operational efficiency, platform usability, and user experience. • In addition to core benefit functionality, this role oversees the administration of complex client hierarchies that mirror real-world organizational structures, ensuring scalable and flexible configuration across enterprise customers. • The Product Manager also drives the evolution of the Member Portal, delivering intuitive, self-service capabilities that improve engagement, transparency, and satisfaction. • At the platform level, they shape the enterprise navigation framework within RxIQ to ensure consistent, logical, and efficient user flows across modules supporting role-based workflows without extending into identity and access management ownership. • By deeply understanding customer workflows, industry standards, and compliance considerations, the Product Manager identifies opportunities to streamline benefit processing, improve financial accuracy, reduce friction across stakeholders, and enhance program performance. • They translate business and market needs into clearly defined product requirements, prioritized backlogs, and outcome-based success metrics. Through close partnership with engineering, architecture, operations, and commercial teams, they ensure scalable, reliable, and compliant solutions are delivered with clarity around scope, acceptance criteria, and quality expectations. • The role also drives continuous improvement through data-driven experimentation and iteration—leveraging launch results, performance metrics, and customer feedback to optimize capabilities, expand impact, and inform strategic investment decisions. As the product manager for these critical benefit platforms and enterprise experience layers, this leader ensures alignment across cross-functional teams while maintaining a strong focus on long-term platform scalability, customer value, and business growth.
Job Requirements
- 4+ years of experience at a PBM or healthcare organization, with direct exposure to Coordination of Benefits (COB), Medicaid, and/or Medicare programs.
- 4+ years working within agile product teams, business functions, or related environments.
- Experience with benefit administration platforms, organizational hierarchy models, or enterprise SaaS configuration tools strongly preferred.
- Familiarity with member-facing web or mobile portal experiences and UX considerations.
- Understanding of enterprise SaaS navigation frameworks and cross-module user experience design.
- Experience using JIRA (or similar tools) for roadmap planning, backlog management, sprint visualization, and prioritization.
- Proven ability to self-manage, make data-driven decisions, and operate both autonomously and collaboratively in cross-functional environments.
- Strong written and verbal communication skills, with demonstrated ability to align engineering, operations, compliance, and commercial stakeholders.
- Strategic mindset with the ability to connect platform scalability, customer value, compliance requirements, and business growth objectives.
Benefits
- Health insurance
- 401(k) matching
- Flexible work hours
- Paid time off
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Product Manager, COB, Pharma CoPay Programs, Client Organization Model Administration
RxSenseAdvanced Technologies. Powerful Results.
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 Product Manager owns the strategy, roadmap, and delivery of core healthcare benefit solutions, including Coordination of Benefits (COB), Pharma Copay programs, Client Organization Model Administration (Hierarchy), the Member Portal experience, and high-level Benefit Administration Portal navigation. This role is responsible for defining and executing a product vision that delivers measurable value to payers, PBMs, pharmacies, manufacturers, and ultimately patients—balancing regulatory requirements, operational efficiency, platform usability, and user experience. In addition to core benefit functionality, this role oversees the administration of complex client hierarchies that mirror real-world organizational structures, ensuring scalable and flexible configuration across enterprise customers. The Product Manager also drives the evolution of the Member Portal, delivering intuitive, self-service capabilities that improve engagement, transparency, and satisfaction. At the platform level, they shape the enterprise navigation framework within RxIQ to ensure consistent, logical, and efficient user flows across modules supporting role-based workflows without extending into identity and access management ownership. By deeply understanding customer workflows, industry standards, and compliance considerations, the Product Manager identifies opportunities to streamline benefit processing, improve financial accuracy, reduce friction across stakeholders, and enhance program performance. They translate business and market needs into clearly defined product requirements, prioritized backlogs, and outcome-based success metrics. Through close partnership with engineering, architecture, operations, and commercial teams, they ensure scalable, reliable, and compliant solutions are delivered with clarity around scope, acceptance criteria, and quality expectations. The role also drives continuous improvement through data-driven experimentation and iteration—leveraging launch results, performance metrics, and customer feedback to optimize capabilities, expand impact, and inform strategic investment decisions. As the product manager for these critical benefit platforms and enterprise experience layers, this leader ensures alignment across cross-functional teams while maintaining a strong focus on long-term platform scalability, customer value, and business growth. To Be Successful in This Role, the Ideal Candidate Will - Develop deep expertise across Coordination of Benefits (COB), Pharma Copay programs, Client Organization Model Administration (Hierarchy), Member Portal experiences, and Benefit Administration Portal navigation. - Understand how enterprise client hierarchies mirror real-world organizational structures and how those structures drive benefit configuration, eligibility, reporting, and operational workflows. - Distill complex healthcare benefit, compliance, and platform concepts into clear, actionable insights for both technical and non-technical stakeholders. - Balance regulatory requirements, operational efficiency, financial accuracy, and user experience when defining product direction. - Think holistically about the enterprise platform experience—ensuring cohesive navigation and intuitive workflows across modules. Expectations - Serve as the subject matter expert for COB, Pharma Copay programs, Client Organization Model Administration (Hierarchy), Member Portal capabilities, and Benefit Administration Portal navigation within RxIQ. - Lead strategy and execution for system enhancements, new client implementations, RFP support, and configuration models across these domains. - Ensure client organizational structures are scalable, flexible, and accurately represented within the platform to support complex enterprise needs. - Drive evolution of the Member Portal to enhance self-service capabilities, transparency, and engagement for end users. - Shape and optimize high-level enterprise navigation patterns to ensure consistent, logical, and efficient user flows across the RxIQ platform (excluding direct IAM ownership). - Remain current with regulatory and industry requirements (COB, Medicare, Medicaid, and related benefit regulations) to ensure ongoing compliance. - Partner with engineering, architecture, operations, and commercial teams to define quarterly roadmaps aligned to long-term platform vision. - Collaborate across adjudication and other core enterprise product areas to maintain a comprehensive understanding of the full RxSense platform ecosystem. - Own and manage the product backlog, prioritizing development based on measurable business impact, customer value, scalability, and risk mitigation. - Develop detailed feature specifications with clear acceptance criteria and outcome-based success metrics. - Leverage data, performance metrics, launch outcomes, and customer feedback to drive continuous improvement and strategic investment decisions. - Demonstrate strong systems thinking and intellectual curiosity to understand how benefit logic, hierarchy models, and enterprise workflows function at a foundational level. - Define and execute a forward-looking strategy across benefit platforms and enterprise experience layers that aligns with RxSense business goals and customer needs. Desired Skills & Experience - 4+ years of experience at a PBM or healthcare organization, with direct exposure to Coordination of Benefits (COB), Medicaid, and/or Medicare programs. - 4+ years working within agile product teams, business functions, or related environments. - Experience with benefit administration platforms, organizational hierarchy models, or enterprise SaaS configuration tools strongly preferred. - Familiarity with member-facing web or mobile portal experiences and UX considerations. - Understanding of enterprise SaaS navigation frameworks and cross-module user experience design. - Experience using JIRA (or similar tools) for roadmap planning, backlog management, sprint visualization, and prioritization. - Proven ability to self-manage, make data-driven decisions, and operate both autonomously and collaboratively in cross-functional environments. - Strong written and verbal communication skills, with demonstrated ability to align engineering, operations, compliance, and commercial stakeholders. - Strategic mindset with the ability to connect platform scalability, customer value, compliance requirements, and business growth objectives. Salary Range: 100,000 - 149,000 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.
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 Product Manager – Clinical & Authorization Platforms owns the strategy, roadmap, and execution of RxSense’s clinical rules infrastructure and prior authorization capabilities. This role is responsible for the platform functionality that enables clients to configure, operationalize, and scale their clinical policies and utilization management programs. RxSense serves enterprise PBMs and healthcare organizations that define their own clinical criteria. The Product Manager ensures those client-defined rules—such as prior authorization requirements, step therapy protocols, quantity limits, refill-too-soon controls, and specialty restrictions—are accurately translated into configurable system logic and efficient workflows within the RxSense platform. This role balances flexibility and standardization, ensuring the platform supports complex client configurations while maintaining performance, scalability, automation, and a high-quality provider and member experience. To Be Successful in This Role, the Ideal Candidate Will - Develop deep expertise in prior authorization, utilization management, and clinical edit frameworks. - Understand how PBM-defined clinical criteria must be operationalized within configurable systems. - Think holistically across adjudication engines, accumulators, benefit design, network configurations, and hierarchy-based (OCAG) inheritance models. - Translate client requirements into scalable product capabilities rather than one-off custom solutions. - Balance automation and human review workflows to optimize efficiency without compromising clinical controls. - Use performance data to continuously refine rule precision, reduce false positives, and minimize provider/member friction. - Demonstrate strong systems thinking, recognizing how clinical rules interact across the broader RxSense platform architecture. Expectations Clinical Rules Infrastructure Ownership - Own the end-to-end clinical rules framework within the platform. - Ensure accurate implementation of client-defined clinical criteria into configurable system logic. - Design scalable configuration models that support multiple enterprise clients without degrading performance. - Maintain consistency between formulary integration, clinical edits, and authorization workflows. Authorization Workflow Strategy - Lead the evolution of electronic PA submission, review, approval/denial, exception, and appeals processes. - Improve authorization turnaround times and automation rates. - Ensure determination messaging is clear, actionable, and configurable to meet client needs. Platform Governance & Quality - Maintain traceability between client requirements, system configuration, and adjudication outcomes. - Partner with internal clinical SMEs and client stakeholders to implement updates tied to drug launches, safety changes, and rule adjustments. - Define and monitor KPIs that measure workflow efficiency, automation, and rule effectiveness. Product Leadership & Execution - Own and prioritize the clinical platform backlog based on enterprise scalability, client impact, and operational value. - Develop detailed feature specifications with measurable outcomes and acceptance criteria. - Collaborate closely with engineering, architecture, clinical SMEs, operations, and commercial teams. - Support client implementations and platform rollouts tied to clinical functionality. Desired Skills & Experience - 4+ years of experience in a PBM, health plan, or healthcare technology environment with direct exposure to prior authorization and utilization management workflows. - 4+ years working within agile product teams, healthcare operations, or related environments. - Experience working with clinical rules engines, decision support systems, or authorization platforms. - Strong understanding of how clinical criteria are operationalized within adjudication and workflow systems. - Familiarity with ePA standards and healthcare interoperability (e.g., NCPDP SCRIPT, FHIR). - Experience operating within agile product environments and managing roadmaps/backlogs in JIRA (or similar tools). - Proven ability to communicate effectively across engineering, clinical, operational, and executive stakeholders. - Strategic mindset with the ability to connect platform capabilities to client needs and business growth objectives. Salary Range: 100,000 - 149,000 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.
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We are looking to hire ambitious entrepreneurs to start and scale their own startups. We are serial entrepreneurs, for example Paul Müller (founder Adjust, €1.2B exit) and Petter Made (founder SumUp, €8B) who are eager to support outlier personalities and serial entrepreneurs to build €1B+ companies. Our offer: - A salary while you build your startup as you will directly be employed by us. Alternatively, you can opt for up to €500k in funding. - 1:1 sparring with unicorn founders on a weekly basis - Community: Access to the top 0.1% of founders, peers and investors - Team building: Hiring top notch talent supported through our network (over 50,000 professionals) - Distribution: Support in reaching product-market-fit and building up a sales force / marketing machine - Funding support for securing a multi-million euro funding round within 12 months (on average, EWOR Fellows raise > €2M after our Grand Pitch) One of our fellows set a record for Europe’s largest pre-seed round by a first-time founder, securing a €12M pre-seed investment. Tasks - You will own, build, and run your startup in fields such as Fintech - You will embark on an extensive personal development journey crafted by unicorn founders and follow a fully customised programme enhancing your goal, time, and energy management - You will receive support in hiring through our network to over 50,000 professionals and advice as well as best practices from serial entrepreneurs - You will receive intensive coaching to make your startup ready to raise millions in funding - You will iterate your product with us until having reached product-market-fit and receive support in building up a sales force or creating a marketing engine respectively Requirements - You are based in Europe or the Americas or open to relocate - You are willing to take full responsibility for your own startup and scale it to €100M+ in revenues - You have excellent communication skills in the English language


