PBM Program Coordinator (OSI #10110836)

Posting Details

The OSI enforces New Mexico law on insurance matters, including consumer protections, review of insurance forms and rates for accuracy and fairness, and helps New Mexicans address insurance concerns. We oversee and regulate most kinds of insurance in New Mexico and we license the individuals and agencies that sell insurance in the state.

Interviews will be conducted within two weeks of the position closing.

Why does the job exist?

The PBM Program Manager is responsible for the strategic development, oversight, and day-to-day management of New Mexico's regulatory framework for Pharmacy Benefit Managers (PBMs). This role ensures compliance with applicable statutes and regulations, resolves stakeholder complaints, and leads proactive policy and outreach initiatives. The Program Manager collaborates with internal teams, external partners, and the public to promote fairness, transparency, and accountability in PBM operations throughout the state.

How does it get done?

1. Regulatory Program Development and Oversight

Design, implement, and manage a statewide regulatory structure for PBMs operating in New Mexico.

Develop and maintain policies, procedures, and internal systems for monitoring PBM compliance.

Coordinate with licensing, enforcement, and legal teams to ensure PBMs meet all statutory requirements.

Oversee timely submission of required filings and documentation from PBMs.

2. Compliance Monitoring and Complaint Resolution

Lead the intake, investigation, and resolution of complaints against PBMs.

Conduct compliance reviews and investigations in alignment with state regulations.

Collaborate with legal counsel to support enforcement actions and document findings.

Maintain a tracking system for complaints and identify patterns or repeat violations.

3. Stakeholder Engagement, Outreach, and Education

Serve as the primary liaison between OSI and PBMs, pharmacies, healthcare providers, and other stakeholders.

Develop and deliver educational materials, trainings, and public webinars.

Promote stakeholder understanding of PBM regulations and complaint processes.

Respond promptly to public and stakeholder inquiries.

4. Policy Research, Legislative Advocacy, and Best Practices

Research PBM regulatory models and emerging best practices in other states.

Analyze and prepare fiscal impact reports and legislative testimony.

Track relevant legislative and regulatory developments at the state and national levels.

Collaborate with national peer networks and regulatory agencies.

5. Program Evaluation and Reporting

Establish and monitor program metrics and key performance indicators.

Prepare internal and external reports detailing program effectiveness and compliance trends.

Identify areas for process improvement and propose strategic enhancements.

Conduct annual program reviews and submit findings to leadership and stakeholders.

6. Database Management and Recordkeeping

Maintain a secure, accurate, and up-to-date PBM compliance database.

Ensure confidentiality and integrity of sensitive data.

Produce data reports to support regulatory decisions and program evaluations.

Who are the customers?

The work is done for the citizens of the State of New Mexico.

Ideal Candidate

The work is done for the citizens of the State of New Mexico.

Minimum Qualification

Associate's Degree and two (2) years of experience program administration or project management in areas related to the purpose of the position. Any combination of education and/or direct experience in this occupation totaling four (4) years may substitute for the required education and experience.

Employment Requirements

Must possess a valid New Mexico Driver's license, a current defensive driving course certification from the State of New Mexico or must pass Defensive Driving Course Certificate within six months of the date of hire as a condition of continued employment. .

Working Conditions

Work is performed in an office setting with exposure to Visual/Video Display Terminal (VDT) and extensive personal computer and phone usage. Extensive sitting, some standing, bending and reaching may be required.

Supplemental Information

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For information on Statutory Requirements for this position, click the Classification Description link on the job advertisement.

Bargaining Unit Position

This position is not covered by a collective bargaining agreement.