PBM Business Integration Specialist

JD:

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.

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Skill

Required / Desired

Amount

of Experience



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

Required

3

Years



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

Required

3

Years



Skills to handle multiple priorities and manage communications professionally to achieve issue resolution with customers, employees, or management

Required

3

Years



Knowledge of the Medicaid Pharmacy (PBM) processes, roles, and intended outcomes

Required

3

Years



Drug information skills

Required

3

Years



Experience in ensuring with all applicable policies and procedures.

Required

3

Years



Knowledge of the Enterprise IT Systems integration principle and associated change management best practices

Desired

1

Years



Demonstrate ability to manage multiple priorities and projects, and function in a fast passed moving constantly changing, deadline-driven environment

Required

3

Years



Proficient in Microsoft Word, Excel, PowerPoint, Access, and Adobe software

Required

3

Years



Experience in reviewing and providing feedback and input to senior level decision-makers to develop long-range strategic alternatives for business sol

Required

3

Years



Experience working in a combination of business analysis. Product management, project management, and or software application development

Required

3

Years



Excellent communication skills and attention to detail with specific experience developing, editing, and presenting summaries, reports, and complex in

Required

3

Years



Proven experience and working knowledge of the agile development methodologies, environment and tools

Highly desired

2

Years



Experience handling HIPPA and PII data

Required

3

Years



Managed care knowledge or experience

Required

3

Years



Medicaid program knowledge or related Healthcare Information experience

Required

3

Years

Job Type: Contract

Pay: $ $60.00 per hour

Expected hours: 40 per week

Work Location: In person