PBM Business Integration Specialist
1 week ago
Responsibilities:
- Supports one plus 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.
- bility 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.
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