PBM Business Integration Specialist

3 weeks ago


Raleigh, United States Sunrise Systems, Inc. Full time
Job Title: PBM Business Integration Specialist
Job Id:  24-04987
Location: Raleigh, NC (Hybrid)
Duration: 01 Months On Contract

Roles and 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 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.


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