PBM Business Integration Specialist (Pharmacist)
BC Forward

PBM Business Integration Specialist (Pharmacist)

BCforward is currently seeking a highly motivated PBM Business Integration Specialist (Pharmacist) Professional Job for an opportunity at Raleigh, NC!

Position Title: PBM Business Integration Specialist (Pharmacist)
Location: Raleigh, NC
Duration: 1 plus Months contract and the possibility to be extended the contract.
Pay Rate: $55/hr on W2

Description:
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.

Skills:
Graduation from an accredited School of Pharmacy, B.S. or Doctor of Pharmacy degree, Required
Registered Pharmacist with a valid (active) and unrestricted Pharmacist license , Required3Years
Licensed to practice pharmacy in the State of North Carolina or the ability to receive the North Carolina license to practice Pharmacy within 90 days , Required
Understanding of pharmacy lines of business: retail, long term care, home infusion, mail order, specialty, institutional, Required3Years
Skills to handle multiple priorities and manage communications professionally to achieve issue resolution with customers, employees, or management, Required3Years
Knowledge of the Medicaid Pharmacy (PBM) processes, roles, and intended outcomes , Required3Years
Drug information skills, Required3Years
Experience in ensuring with all applicable policies and procedures. , Required3Years
Knowledge of the Enterprise IT Systems integration principle and associated change management best practices , Desired1Years
Demonstrate ability to manage multiple priorities and projects, and function in a fast passed moving constantly changing, deadline-driven environment , Required3Years
Proficient in Microsoft Word, Excel, PowerPoint, Access, and Adobe software , Required3Years
Experience in reviewing and providing feedback and input to senior level decision-makers to develop long-range strategic alternatives for business sol, Required3Years
Experience working in a combination of business analysis. Product management, project management, and or software application development , Required3Years
Excellent communication skills and attention to detail with specific experience developing, editing, and presenting summaries, reports, and complex in, Required3Years
Proven experience and working knowledge of the agile development methodologies, environment and tools , Highly desired2Years
Experience handling HIPPA and PII data , Required3Years | Managed care knowledge or experience , Required3Years
Medicaid program knowledge or related Healthcare Information experience , Required3Years

Benefits:
BCforward offers all eligible employees a comprehensive benefits package including, but not limited to major medical, HSA, dental, vision, employer-provided group life, voluntary life insurance, short-term disability, long-term disability, and 401k.

About BCforward:
Founded in 1998 on the idea that industry leaders needed a professional service, and workforce management expert, to fuel the development and execution of core business and technology strategies, BCforward is a Black-owned firm providing unique solutions supporting value capture and digital product delivery needs for organizations around the world. Headquartered in Indianapolis, IN with an Offshore Development Center in Hyderabad, India, BCforward's 6,000 consultants support more than 225 clients globally.

BCforward champions the power of human potential to help companies transform, accelerate, and scale. Guided by our core values of People-Centric, Optimism, Excellence, Diversity, and Accountability, our professionals have helped our clients achieve their strategic goals for more than 25 years. Our strong culture and clear values have enabled BCforward to become a market leader and best in class place to work.

BCforward is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, or protected veteran status and will not be discriminated against based on disability.

To learn more about how BCforward collects and uses personal information as part of the recruiting process, view our Privacy Notice and CCPA Addendum. As part of the recruitment process, we may ask for you to disclose and provide us with various categories of personal information, including identifiers, professional information, commercial information, education information, and other related information. BCforward will only use this information to complete the recruitment process.

This posting is not an offer of employment. All applicants applying for positions in the United States must be legally authorized to work in the United States. The submission of intentionally false or fraudulent information in response to this posting may render the applicant ineligible for the position. Any subsequent offer of employment will be considered employment at-will regardless of the anticipated assignment duration.

Interested candidates please send resume in Word format Please reference job code 231111 when responding to this ad.

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Job Snapshot

Employee Type
Contractor

Location
Raleigh, NC (Onsite)

Job Type
Pharmaceutical

Experience
Not Specified

Date Posted
11/08/2024