MES PBM Business Integration Specialist

3 days ago

Charlotte, NC, United States Cynet Systems Full time
Job Description:

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 tthe 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.
  • bility tresearch and recommend the development and implementation of business initiatives of the product enhancements.
  • Provides feedback and input tsenior level decision-makers tdevelop long-range strategic alternatives for business solutions.
  • Preferred thave 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 intdetailed 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 tachieve 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 tdevelop the strategy behind how each MES module will support the business requirements definition as well translation and specification of all functional requirements.
Education and Experience (Required):
  • Graduation from an accredited School of Pharmacy.
  • B.S. or Doctor of Pharmacy degree required.
  • Registered Pharmacist with a valid and unrestricted Pharmacist license
  • 3+ years of professional experience, preferably within a Medicaid agency or Pharmacy Benefit Manager (PBM).
  • Understanding of pharmacy lines of business: retail, long term care, home infusion, mail order, specialty, institutional.
  • Drug information skills.
  • nalytical skills.
  • Computer proficiency with Microsoft Office (Word, Excel, PowerPoint) products.
  • Skills thandle multiple priorities and manage communications professionally tachieve issue resolution with customers, employees, or management.

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