Business Integration Specialist

3 weeks ago

Raleigh, United States Crescens Full time
Job Title: Business Integration Specialist
Location: Raleigh NC - (Onsite)
Duration: 12+ Months

***This is an Onsite position. ***

Job Responsibilities:
  • 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 Client, 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.
  • Drug Utilization Review (DUR) and pharmacy lock-in related processes o 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.

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
  • Analytical skills
  • Computer proficiency with Microsoft Office (Word, Excel, PowerPoint) products
  • Skills to handle multiple priorities and manage communications professionally to achieve issue resolution with customers, employees, or management. License or Certification required by statue or regulation: (Is a license or certificate required? What kind and type?)
  • 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 of hire.

Required skills:
  • Graduation from an accredited School of Pharmacy, B.S. or Doctor of Pharmacy degree
  • Registered Pharmacist with a valid and unrestricted Pharmacist license
  • 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
  • Understanding of pharmacy lines of business: retail, long term care, home infusion, mail order, specialty, institutional
  • Skills 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.
  • Knowledge of the Enterprise IT Systems integration principle and associated change management best practices
  • Demonstrate ability 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
  • Excellent communication skills and attention to detail with specific experience developing, editing, and presenting summaries, reports, and complex in
  • Proven experience and working knowledge of the agile development methodologies, environment and tools
  • Experience handling HIPPA and PII data
  • Managed care knowledge or experience
  • Medicaid program knowledge or related Healthcare Information experience

  • Pharmacist Business Integration Specialist

    3 weeks ago

    Raleigh, United States Crescens Inc. Full time

    Job Title: Pharmacist Business Integration Specialist Location: Raleigh, NC Duration: 12+ Months (Extendable upto 3 years) Type : Contract Job Description: 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...

  • MES PBM Business Integration Specialist

    3 weeks ago

    Raleigh, United States Serigor Inc. Full time

    Job Title: MES PBM Business Integration Specialist (Pharmacist) (Hybrid)Location: Raleigh, NCDuration: 12+ MonthsJob Description:The PBM Business Integration Specialist will serve as a member of the client Medicaid Enterprise System (MES) Program within Pharmacy Business space. The PBM Business Integration Specialist will provide expertise and business...

  • EHR Integration Specialist

    1 month ago

    Raleigh, United States JSM Consulting Full time

    ***The candidate will be allowed to work remotely but will be expected to work onsite once staff return to site. The candidate will need to come onsite the first day to collect equipment. ***US Citizenship is required. ***Fingerprint background check is required.The Electronic Health Record (EHR) Integration Specialist participates in all phases of...

  • EHR Integration Specialist

    1 month ago

    Raleigh, North Carolina, United States JSM Consulting Full time

    The candidate will be allowed to work remotely but will be expected to work onsite once staff return to site. The candidate will need to come onsite the first day to collect equipment. US Citizenship is required. ***Fingerprint background check is required.The Electronic Health Record (EHR) Integration Specialist participates in all phases of connecting EHR...

  • Payment Integrity Client Success Specialist

    6 hours ago

    Raleigh, United States The Carolinas Center for Medical Excellence Full time

    Payment Integrity Client Success Specialist Remote Who We Are: Constellation Quality Health, formerly CCME, is a non-profit health care quality organization and QIO-like Entity certified by the Centers for Medicare & Medicaid Services (CMS) founded by physicians in 1983. Headquartered in North Carolinas Research Triangle, we offer an array of quality...

  • Business Specialist

    3 weeks ago

    Raleigh, North Carolina, United States Hitachi Careers Full time

    Description General Information:Hitachi Energy is seeking for a Business Specialist for our Raleigh, NC office. This role is responsible for activities related to the Transformers business within the North America (NAM) Region.Your responsibilities:Audit and analyze a variety of financial information used in the preparation of budgets, forecasts, business...

  • Developer Relations Specialist

    3 weeks ago

    Raleigh, United States Envestnet Asset Management, Inc Full time

    Developer Relations Specialist - Integration and API Support page is loaded Developer Relations Specialist - Integration and API Support Apply locations Raleigh time type Full time posted on Posted 30+ Days Ago job requisition id Req 20.333 - It's fun to work in a company where people truly BELIEVE in what they're doing! We're committed to bringing passion...

  • MES Integration Specialist

    1 month ago

    Raleigh, United States JSM Consulting Full time

    Knowledge of the Medicaid Systems and Solutions Required 7years Knowledge of the MITA Business Information and Technical architectures Required 7years Extensive familiarity with relational databases as well as other types (Graph Database NoSQL) and the relative advantages and disadvantages of each Required 7 Years Extensive familiarity with business...

  • MES Integration Specialist

    1 month ago

    Raleigh, North Carolina, United States JSM Consulting Full time

    Knowledge of the Medicaid Systems and Solutions Required 7years Knowledge of the MITA Business Information and Technical architectures Required 7years Extensive familiarity with relational databases as well as other types (Graph Database NoSQL) and the relative advantages and disadvantages of each Required 7 Years Extensive familiarity with business...

  • DVRS Business Analyst Specialist

    2 weeks ago

    Raleigh, United States Cynet Systems Full time

    Job Description: Specialist-level BA is needed to assist with implementing Phase 2 of a new Case Management Solution. This development effort is being performed in multiple phases. Phase 1 has been completed. This position is required to work in a rapid-paced development team environment that uses JavaScript, VBScript, Visual Basic, .NET, and SQL Server....

  • Business Support Specialist IV

    7 days ago

    Raleigh, United States Integrated Resources Full time

    Job Title; Business Support Specialist IV (note the level) Location: Raleigh, North Carolina Onsite Job Description: The Business Support Specialist reports to the Business Support Supervisor of the North America Purchase to Pay (PTP) team and is responsible for taking an active role in executing, improving, and supporting the customer service framework in...

  • HR Specialist Sr

    2 days ago

    Raleigh, United States UNC Medical Center Full time

    UNC Health Rex is a 660-bed, not-for-profit hospital that began serving Raleigh and the surrounding communities in 1894. We offer an array of services including emergency care, inpatient and outpatient care, skilled nursing facilities, and ambulatory HR Specialist, Business Partner, HR, Business, Specialist, Processing, Healthcare

  • Salesforce Senior Business and Technical Specialist

    3 days ago

    Raleigh, United States LanceSoft Full time

    The Client requires the services of a senior business and technical specialist to support business case analysis, process reengineering, requirement gathering activities and assist with Tier-3 support for the COVID vaccine project(CVMS). The CVMS solution is developed based on Salesforce platform and using agile methodology. Responsibilities include: Build...

  • InputAccel Capture Specialist

    1 month ago

    Raleigh, United States Software People Full time

    Position InputAccel Capture SpecialistLocation Raleigh NCDuration 12+ monthsResponsibilitiesWorking with the Enterprise Services Manager the Technical Specialist (Expert) is the lead InputAccel Capture Specialist for the Enterprise Capture Solution to ensure we address the Customer’s immediate business needs. Included but not limiting this resource...

  • InputAccel Capture Specialist

    1 month ago

    Raleigh, North Carolina, United States Software People Full time

    Position InputAccel Capture SpecialistLocation Raleigh NCDuration 12+ monthsResponsibilitiesWorking with the Enterprise Services Manager the Technical Specialist (Expert) is the lead InputAccel Capture Specialist for the Enterprise Capture Solution to ensure we address the Customer's immediate business needs. Included but not limiting this resource will be...

  • GIS Technical Specialist

    2 weeks ago

    Raleigh, United States NR Consulting Full time

    Job Title: GIS Technical Specialist Location: Raleigh, NC (Remote) Position Type: Contract with possible extension Duration: 12+ months Short Description: The Technical Specialist is a senior level resource with specialized knowledge and experience in a specific technology. Complete Description: The Technical Specialist is a senior level resource...

  • Technical Specialist- Junior

    1 day ago

    Raleigh, United States BCforward Full time

    Technical Specialist- Junior BCforward is currently seeking highly motivated Technical Specialist- Junior in Raleigh, NC 27610Position Title: Technical Specialist- Junior Location: Raleigh, NC 27610 Shift Timing: Mon - Friday 40.00 Hours Per Week Anticipated start date: 1- 3 Weeks Duration: 12 month contract and possibility to be extended the contract. Pay...

  • Verifications Specialist

    1 day ago

    Raleigh, United States CriminalRecordCheck.com Full time

    Verifications Specialist Full time - Remote Must be a resident in the state of North Carolina. CriminalRecordCheck.com (CRC) is an accredited provider of background screening services. Our risk management solutions are important tools for making critical decisions in today's business environment. Our Mission is to provide straightforward and diligent...

  • Business Analyst and Technical Specialist

    7 days ago

    Raleigh, United States Serigor Inc. Full time

    Job DescriptionJob DescriptionJob Title: Business Analyst and Technical Specialist (Remote)Location: Raleigh, NCDuration: 12+ MonthsJob Description:This position will be serving as the product manager for electronic certified payroll for the construction team, as it relates to our software.  This position is responsible for delivering business and system...

  • Business Analyst and Technical Specialist

    1 month ago

    Raleigh, United States Serigor Inc. Full time

    Job DescriptionJob DescriptionJob Title: Business Analyst and Technical Specialist (Remote)Location: Raleigh, NCDuration: 12+ MonthsJob Description:This position will be serving as the product manager for electronic certified payroll for the construction team, as it relates to our software.  This position is responsible for delivering business and system...