PBM Business Integration Specialist
We are seeking a Pharmacist as a Pharmacy Benefits Management (PBM) 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 and 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.
Required
Experience:
Understanding of pharmacy lines of business:
retail, long term care, home infusion, mail order, specialty, institutional Experience to handle multiple priorities and manage communications professionally to achieve issue resolution with customers, employees, or management Knowledge of the Medicaid Pharmacy (PBM) processes, roles, and intended outcomes Drug information skills Experience in ensuring with all applicable policies and procedures.
Demonstrate experience to manage multiple priorities and projects, and function in a fast passed moving constantly changing, deadline-driven environment Proficient in Microsoft Word, Excel, PowerPoint, Access, and Adobe software Experience in reviewing and providing feedback and input to senior level decision-makers to develop long-range strategic alternatives for business sol Experience working in a combination of business analysis.
Product management, project management, and or software application development Proven experience and working knowledge of the agile development methodologies, environment and tools Experience handling HIPPA and PII data Medicaid program knowledge or related Healthcare Information experience Required Education:
Graduation from an accredited School of Pharmacy, B.
S.
or Doctor of Pharmacy degree Required Certification:
Registered Pharmacist with a valid (active) and unrestricted Pharmacist license Roles and
Responsibilities:
Supports one or more Pharmacy business process areas, including.
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) 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.
Recommended Skills Adobe Agile Methodology Behavioral Medicine Business Analysis Business Management Business Processes Estimated Salary: $20 to $28 per hour based on qualifications.
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.
Required
Experience:
Understanding of pharmacy lines of business:
retail, long term care, home infusion, mail order, specialty, institutional Experience to handle multiple priorities and manage communications professionally to achieve issue resolution with customers, employees, or management Knowledge of the Medicaid Pharmacy (PBM) processes, roles, and intended outcomes Drug information skills Experience in ensuring with all applicable policies and procedures.
Demonstrate experience to manage multiple priorities and projects, and function in a fast passed moving constantly changing, deadline-driven environment Proficient in Microsoft Word, Excel, PowerPoint, Access, and Adobe software Experience in reviewing and providing feedback and input to senior level decision-makers to develop long-range strategic alternatives for business sol Experience working in a combination of business analysis.
Product management, project management, and or software application development Proven experience and working knowledge of the agile development methodologies, environment and tools Experience handling HIPPA and PII data Medicaid program knowledge or related Healthcare Information experience Required Education:
Graduation from an accredited School of Pharmacy, B.
S.
or Doctor of Pharmacy degree Required Certification:
Registered Pharmacist with a valid (active) and unrestricted Pharmacist license Roles and
Responsibilities:
Supports one or more Pharmacy business process areas, including.
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) 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.
Recommended Skills Adobe Agile Methodology Behavioral Medicine Business Analysis Business Management Business Processes Estimated Salary: $20 to $28 per hour based on qualifications.
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