Terms of Employment
Duration: W2 Contract-to-Hire, 6-Months
Location: 100% Remote (Must reside within approved client target states; travel required maximum once per quarter)
Overview
Client is seeking a Senior Principal Solution Architect to partner with a leading healthcare organization. In this role, you will lead high-profile solution architecture initiatives within the Enterprise Architecture team, focusing on Pharmacy Benefit Management (PBM) pre-planning and system integration. You will serve as the architectural link between external PBM partners and internal core healthcare payer platforms.
Key Responsibilities
Lead architectural solutions and pre-planning efforts for Pharmacy Benefit Management (PBM) and pharmacy operations integrations.
Design interoperability solutions between third-party PBM platforms and core in-house systems using APIs, event-driven, batch, and real-time integration methods.
Architect solutions accommodating healthcare standards including CMS requirements, NCPDP standards, and HIPAA EDI transaction sets.
Collaborate with and lead domain architects across Cybersecurity, Enterprise Data, and Core Claims.
Support the end-to-end pharmacy benefit lifecycle, including formulary/drug list management, prior authorization, step therapy, quantity limits, and accumulator management.
Required Qualifications
Minimum 10 years of experience operating as a Solution Architect within the healthcare payer industry.
Approximately 10 cumulative years of experience in PBM, pharmacy benefit administration, or pharmacy operations architecture.
Demonstrated technical experience with Facets G6.
Mandatory experience with HIPAA EDI transaction sets, specifically 834 and 837.
Deep knowledge of interoperability technologies (HL7 FHIR, REST APIs, event-driven architectures, X12).
Proven track record of leading architectural assignments and collaborating with cross-functional technical teams.
Preferred Qualifications
Hands-on experience with Edifex integration suite.
Familiarity with care management and prior authorization platforms such as Health Edge Guiding Care.
Direct experience integrating third-party PBM engines (e.g., CVS) with payer core systems.