Lead, Pharmacy Credentialing Benefit Management Position Available In Miami-Dade, Florida

• We’re unique. You should be, too.
• We’re changing lives every day.

For both our patients and our team members. Are you innovative and entrepreneurial minded? Is your work ethic and ambition off the charts? Do you inspire others with your kindness and joy? We’re different than most primary care providers. We’re rapidly expanding and we need great people to join our team. The Lead, Pharmacy Credentialing Benefit Manager (PCBM) is responsible for leading the effort to secure licenses and permits from state and federal agencies, and industry contracts for our rapidly increasing number of new dispensaries. The incumbent in this role works directly with PBM contract counterparts to successfully manage the credentialing and recredentialing of new and existing center dispensaries. The Lead, PCBM is also accountable for assessing and providing continuous improvement recommendations for credentialing processes, co-facilitating improvement design sessions in coordination with Med COE, IT and NICU team members and training respective departments on processes and guidelines. He/She serves as the primary point of contact for resolving center questions and issues related to PBM contracts.

• ESSENTIAL JOB DUTIES/RESPONSIBILITIES

• + Leads effort to gather required information from internal departments and then complete and submit permit and licensing applications, and other submissions to state, federal, and local agencies as well as industry partners such as pharmacy benefit managers.

+ Prepares and submits initial applications for expansion state licensing and renewal state licensing for all dispensaries. + Attends new market and new payor calls to identify new dispensary builds, new payor contracts and/or payor initiated PBM changes to ensure identification of key PBM contacts to plan and initiate credentialing discussion. + Schedules new PBM calls to confirm understanding of application and credentialing process. + Maintains relationships with PBMs to ensure re-credentialing + Maintains new dispensary setup and decommissioning in partnership with key market leaders. + Manages communication with PBMs and ensures the execution of yearly compliance attestations and recredentialing requests. + Coordinates and monitors credentialing and dispensing confirmation with Medication COE to ensure all centers are active and dispensing ready. + Partners with Legal, Risk and Office of Chief Quality officer to execute contracts. + Provides credentialing status updates to market leaders. + Supports Credentialing Manager with new market projects. + Identifies process improvement opportunities and presents recommendations to Credentialing Manager and other leadership stakeholders. + Implements improvement opportunities by creating or updating documentation and training resources. + Partners with market leaders to identify primary physician in charge at each location and is responsible for ensuring credentials are renewed and updated. + Performs other duties as assigned and modified at manager’s discretion.

• KNOWLEDGE, SKILLS AND ABILITIES

• + Knowledge of credentialing requirements such as NPI, NCPDP, DEA and HCCE + Knowledge of local, state and federal dispensary regulatory guidelines or other relevant licensing processes and/or contracting + Knowledge and understanding of the PBM credentialing process + Strong analytical, problem solving skills are essential.

Database management skills including querying, reporting and document generation + Professional, motivated and pleasant demeanor + Excellent organizational and follow-up skills with attention to detail and accuracy + Ability to communicate effectively, both verbally and in writing + Informational research skills + Ability to organize and prioritize work and manage multiple priorities simultaneously to meet deadlines + Ability to work independently with minimal supervision + Ability to establish and maintain effective working relationships with external vendors/contacts and internal stakeholders including providers, management, staff + Proficient in Microsoft Office Suite products including Word, Excel, PowerPoint and Outlook, plus a variety of other word-processing, spreadsheet, database, e-mail and presentation software + Ability and willingness to travel locally, regionally and nationwide up to 10% of the time + Spoken and written fluency in English

• EDUCATION AND EXPERIENCE CRITERIA

• + BA/BS degree in Healthcare Administration, Business Administration, Pharmaceutical Sciences or a related field
• OR•additional experience above the minimum will be considered in lieu of the required education on a year-for-year basis required + A minimum of 5 years work experience as a Pharmacy Technician, Pharmacy Credentialing Specialist or a similar role required + Experience with PBM Credentialing, Applications and Contracts with ESI, CVS, OptumRx and others We’re ChenMed and we’re transforming healthcare for seniors and changing America’s healthcare for the better.

Family-owned and physician-led, our unique approach allows us to improve the health and well-being of the populations we serve. We’re growing rapidly as we seek to rescue more and more seniors from inadequate health care. ChenMed is changing lives for the people we serve and the people we hire. With great compensation, comprehensive benefits, career development and advancement opportunities and so much more, our employees enjoy great work-life balance and opportunities to grow. Join our team who make a difference in people’s lives every single day. Current Employee apply HERE (https://careers.chenmed.com/i/us/en/homerevisited) Current Contingent Worker please see job aid HERE to apply #LI-Hybrid