Pharmacy Benefits Regulatory Operations Manager – 1421582-MW_3-4658 Position Available In Pulaski, Arkansas

This job was posted by https://www.arjoblink.arkansas.gov : For moreinformation, please see: https://www.arjoblink.arkansas.gov/jobs/4489707

• Responsibilities
• Oversee PBM Licensing
• ensures Pharmastar is appropriately licensed based on services rendered
• Track state and federal business requirements and manages compliance with associated regulatory reporting
• Contact regulators for clarification and guidance as necessary
• Manage regulatory audit proceedings
• Coodinate pharmacy audits and distributes plan specific audit result letters
• Participate in clients’ CMS financial audits providing documentation and reports as needed
• Research regulatory issues as it relates to clients’ drug benefits and report results to clients
• Develop Corrective Action Plans (CAPs) in response to audit findings
• Monitor Medicare Part D regulation and guidance for applicability to Pharmastar. Assists with facilitating client awareness of regulatory changes
• Responsible for maintaining P&P related to the regulatory compliance of Pharmastar includes drafting and editing
• Provide guidance to the Pharmastar regulatory team, including training and development
• Communicate with staff regarding needs of both the client and the company. Follow up to ensure appropriate action is taken in a timely fashion
• Monitor client utilization and proactively solve issues as they arrive
• Research regulatory issues as it relates to clients’ drug benefits and report results to clients
• Assure departmental compliance with company policies, procedures, standards and regulatory requirements
• Promote staff enthusiasm and teamwork, support others in their job functions
• Ensure that HIPAA guidelines are followed in every communication with clients
• Stay current on plan and benefit structures, pharmacological updates, and Medicare Part D guidelines
• Attend department and company meetings and educational programs upon request.
• Key Responsibilities simplified:
• Oversee PBM licensing across states
• Track and report on compliance with state/federal regulations
• Manage regulatory and pharmacy audits, including CMS audits
• Research and report on regulatory issues for client drug benefits
• Draft and maintain policies and procedures (P&Ps
• Develop and implement Corrective Action Plans (CAPs
• Support the team with training and regulatory updates
• Ensure compliance with HIPAA and company standards
• Monitor client activity and resolve issues proactively

• Ideal Background:

• 5+ years
• in healthcare, pharmacy, or PBM setting
• Strong understanding of
• Medicare Part D
• , PACE programs, and pharmacy benefit structures
• Experience supporting
• regulatory or audit functions at a state level
• Associate’s degree required (or equivalent experience)Beacon Hill is an equal opportunity employer and individuals withdisabilities and/or protected veterans are encouraged to apply.
• California residents:
• Qualified applications with arrest orconviction records will be considered for employment in accordance withthe Los Angeles County Fair Chance Ordinance for Employers and theCalifornia Fair Chance Act.

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Company Profile:

Founded by industry leaders to set a new standard in search, careerplacement and flexible staffing, we deliver coordinated staffing solutions with unparalleled service, a commitment to project completionand success and a passion for innovation, creativity and continuousimprovement.

Our niche brands offer a complete suite of staffing services to emerginggrowth companies and the Fortune 500 across market sectors, careerspecialties/disciplines and industries. Over time, office locations,specialty practice areas and service offerings will be added to addressever changing constituent needs.

Learn more about Beacon Hill and our specialty divisions, Beacon HillAssociates, Beacon Hill Financial, Beacon Hill HR, Beacon Hill Legal,Beacon Hill Life Sciences and Beacon Hill Technologies by visitingwww.bhsg.com .

Benefits Information:

Beacon Hill offers a robust benefit package including, but not limitedto, medical, dental, vision, and federal and state leave programs asrequired by applicable agency regulations to those that meeteligibility. Upon successfully being hired, details will be providedrelated to our benefit offerings.

We look forward to working with you!

Beacon Hill. Employing the Future