Pbm Compliance Jobs in Raleigh, NC (NOW HIRING)

NC Department of Health and Human Services (DHHS) seeks a Pharmacist as a Pharmacy Benefits Management (PBM) Business Integration Specialist to join the Medicaid Enterprise System (MES) project.
The PBM Business Integration Specialist will serve as a member of the DHHS Medicaid Enterprise System (MES) Program within Pharmacy Business space. The PBM Business Integration Specialist will provide expertise and business support to the Pharmacy and Ancillary Services Business Unit in the development and implementation of the Medicaid Enterprise Modular Pharmacy Business Management (PBM) Solution. The PBM Business Integration Specialist, as a Business Subject Matter Expert, will assist the Department to on-board the PBM vendor, serve as a business stakeholder, and represent the Pharmacy Business Unit in the implementation of the complex and innovative PBM Solution.
The primary responsibility of this position is to serve as the subject matter expert and content lead in collaboration with the Pharmacy Business team for Clinical policies and Prior Authorizations, Drug Utilization Review (DUR) and pharmacy lock-in related processes, Behavioral health, and A+ kids, Preferred Drug List (PDL) and Medicaid Drug Rebate Program (MDRP), and Physicians Administered Drug Program (PADP) related to the Medicaid Drug Rebate Program (MDRP).
The Pharmacy team needs a Business Integration Specialist who is dedicated to the PBM Module Implementation and can focus on these work streams as they relate to implementation of the new PBM, in collaboration with the existing pharmacy team.
Knowledge of Medicaid Pharmacy Benefits Management processes, intended outcomes, and pain points is essential.
This position will actively work with the Pharmacy Business team to define and provide the business support in completing the business process documents, Business use cases, Business case scenarios, user acceptance test case scenarios, and documentation in relation to Medicaid initiatives and strategic goals. This position may require interacting with the NC Medicaid Business Information Analytics Office, DHHS Data Office, Information Technology Division, Privacy and Security Office, Policy Office, General Counsel, Office of Procurement, Contracts and Grants, among others.
Roles and Responsibilities
• Supports one or more Pharmacy business process areas, including.
o Clinical policies and Prior Authorizations.
o Drug Utilization Review (DUR) and pharmacy lock-in related processes
o Behavioral health, and A+ kids.
o Preferred Drug List (PDL) and Medicaid Drug Rebate Program (MDRP)
o Physicians Administered Drug Program (PADP) related to the Medicaid Drug Rebate Program (MDRP)
• Supports cross-functional activities that provide effective oversight of Medicaid Programs.
• Collaborates and communicates with the PBM Business stakeholders (Product Managers, Product Owners, Business Leads.)
• In-depth knowledge and understanding of the business needs across functions and business segments in healthcare that meet departmental goals.
• Ability to research and recommend the development and implementation of business initiatives of the product enhancements.
• Provides feedback and input to senior level decision-makers to develop long-range strategic alternatives for business solutions.
• Preferred to have experience with Medicaid, managed care, and Pharmacy Benefit Manager (PBM) operations. areas.
• Prior experience with Medicaid applications and preferably across Pharmacy Functional Areas.
• Communicate with the business owner needs and help translate them into detailed and actionable requirements as needed.
• Ensures compliance with all applicable policies and procedures.
• Supporting the product lifecycle from conception through implementation.
• Performs other duties as assigned.
In addition, the Pharmacy Business Integration Specialist is responsible in supporting the Business Management space to achieve successful development of the Pharmacy Benefit Management Solution in support of the Medicaid program. The Business Integration Specialist will work collaboratively with the Business owner and the rest of the business team to develop the strategy behind how each MES module will support the business requirements definition as well translation and specification of all functional requirements.
  Required/Desired Skills   SkillRequired /DesiredAmountof ExperienceGraduation from an accredited School of Pharmacy, B.S. or Doctor of Pharmacy degreeRequired0 Registered Pharmacist with a valid (active) and unrestricted Pharmacist licenseRequired3YearsLicensed to practice pharmacy in the State of North Carolina or the ability to receive the North Carolina license to practice Pharmacy within 90 daysRequired0 Understanding of pharmacy lines of business: retail, long term care, home infusion, mail order, specialty, institutionalRequired3YearsSkills to handle multiple priorities and manage communications professionally to achieve issue resolution with customers, employees, or managementRequired3YearsKnowledge of the Medicaid Pharmacy (PBM) processes, roles, and intended outcomesRequired3YearsDrug information skillsRequired3YearsExperience in ensuring with all applicable policies and procedures.Required3YearsKnowledge of the Enterprise IT Systems integration principle and associated change management best practicesDesired1YearsDemonstrate ability to manage multiple priorities and projects, and function in a fast passed moving constantly changing, deadline-driven environmentRequired3YearsProficient in Microsoft Word, Excel, PowerPoint, Access, and Adobe softwareRequired3YearsExperience in reviewing and providing feedback and input to senior level decision-makers to develop long-range strategic alternatives for business solRequired3YearsExperience working in a combination of business analysis. Product management, project management, and or software application developmentRequired3YearsExcellent communication skills and attention to detail with specific experience developing, editing, and presenting summaries, reports, and complex inRequired3YearsProven experience and working knowledge of the agile development methodologies, environment and toolsHighly desired2YearsExperience handling HIPPA and PII dataRequired3YearsManaged care knowledge or experienceRequired3YearsMedicaid program knowledge or related Healthcare Information experienceRequired3Years