Solutions Architect (PBM Focused)

Location: 99% remote with one onsite meeting per quarter; candidates must reside in DC, MD, VA, WV, NC, PA, DE, NY, NJ, TX, or FL.

Company

hirify.global is recruiting for a contract-to-permanent opportunity with a major healthcare payer organization in the Maryland/Metro DC area.

What you will do

• Establish strategic technology direction and create solution architecture for complex transformation and modernization initiatives.
• Translate business strategy and requirements into cohesive architectures aligned with enterprise standards, technology patterns, and business capabilities.
• Define end-to-end integration architecture, interfaces, subsystems, deployment targets, and critical design trade-offs.
• Guide implementation governance and ensure delivered solutions comply with enterprise and solution architecture objectives.
• Collaborate with project managers, product managers, product owners, delivery leaders, domain architects, security, data, and technology stakeholders.
• Develop technology migration plans, architecture enablers, and future-ready roadmaps across multiple initiatives or domains.

Requirements

• 10 years of Pharmacy Benefit Management solution architecture experience.
• Deep knowledge of healthcare payer and PBM operations, including pharmacy benefit design, formulary management, drug pricing, claims, rebates, utilization management, specialty pharmacy, eligibility, and provider/member services.
• Strong understanding of the end-to-end pharmacy benefit lifecycle, including benefit configuration, prior authorization, step therapy, claims adjudication, coordination of benefits, and payment reconciliation.
• Experience with healthcare payer architecture and PBM ecosystem integrations across health plans, pharmacies, manufacturers, wholesalers, clearinghouses, providers, members, and regulatory organizations.
• Working knowledge of HIPAA, CMS requirements, NCPDP, HL7, FHIR, X12, Medicare Part D, Medicaid pharmacy requirements, and applicable pharmacy regulations.
• Ability to design API, event-driven, batch, EDI, and real-time integration patterns, including canonical data models, information flows, integration contracts, events, and data governance requirements.

Culture & Benefits

• Contract-to-permanent employment opportunity.
• Primarily remote work arrangement with quarterly onsite collaboration.
• Cross-functional work with business leaders, architects, product teams, delivery teams, and technology centers of excellence.