PBM Business Integration Specialist (Pharmacist) – Hybrid Position Available In Wake, North Carolina

PBM Business Integration Specialist (Pharmacist)

• Hybrid

Title:

PBM Business Integration Specialist (Pharmacist)

• Hybrid
  Mandatory skills:
  PBM, Pharmacy Business Management, PBM Business Integration,
  Pharmacy, Pharmacy Business, Pharmacy Functional, Pharmacy Benefit Management,
  Business Management, Business use cases, Business case scenarios, Business Analysis, Business Process,
  business support, business functions, business segments, business solution, business requirements,
  Microsoft Word, Excel, PowerPoint, Access, Adobe,
  Ancillary Services Business Unit, Pharmacy Business Unit,
  Clinical, Prior Authorizations, Drug Utilization Review, Drug information,
  pharmacy lock-in process, Behavioral health, A+ kids, Preferred Drug List, PDL,
  Medicaid Drug Rebate Program, MDRP, Physicians Administered Drug Program, PADP,
  Medicaid, Managed care, Healthcare, Healthcare Information, Medicaid applications, HIPPA, PII,
  Medicaid Programs, PBM Solution, PBM Module Implementation,
  Medicaid Enterprise Modular Pharmacy Business Management Solution, Medicaid Pharmacy Benefits Management,
  Product management, product enhancement, product lifecycle, user acceptance test, test case scenarios,
  pharmacy business, retail, long term care, home infusion, mail order, specialty, institutional,
  agile, agile development methodologies, agile environment, agile tools,
  Enterprise IT Systems, change management, project management, software application development

Description:

The PBM Business Integration Specialist will serve as a member of the client 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.
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.
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 client module will support the business requirements definition as well translation and specification of all functional requirements.
Required /

Desired Skills:

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 client or the ability to receive the client 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

VIVA USA

is an equal opportunity employer and is committed to maintaining a professional working environment that is free from discrimination and unlawful harassment. The Management, contractors, and staff of

VIVA USA

shall respect others without regard to race, sex, religion, age, color, creed, national or ethnic origin, physical, mental or sensory disability, marital status, sexual orientation, or status as a Vietnam-era, recently separated veteran, Active war time or campaign badge veteran, Armed forces service medal veteran, or disabled veteran. Please contact us at for any complaints, comments and suggestions.

Contact Details :

VIVA USA INC.

3601 Algonquin Road, Suite 425
Rolling Meadows, IL 60008
Employers have access to artificial intelligence language tools (“AI”) that help generate and enhance job descriptions and AI may have been used to create this description. The position description has been reviewed for accuracy and Dice believes it to correctly reflect the job opportunity.
Report this job

Dice Id:

vivausa

Position Id:

BTNCPB24