Must-Have:
• Must have a Laptop/computer with internet to work from home.
• Comfortable providing a Photo ID Copy
Terms of Employment:
• Duration: W2 Contract-to-Hire, 6-Months
• Location: 100% Remote (Must reside within MD, DC, VA, WV, PA, DE, NJ, NY, NC, FL & TX)
Travel required maximum of 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.