State of North Dakota
Pharmacist Pharmacy Benefits Manager
State of North Dakota, Bismarck, North Dakota, us, 58502
Base Pay Range
$96,000.00/yr - $120,000.00/yr
Summary of Work We are seeking a highly knowledgeable and detail-oriented Pharmacy Benefits Management (PBM) Compliance Pharmacist to serve as a subject matter expert in PBMs. This position plays a critical role in enforcing PBM-related laws and regulations, supporting consumer protection initiatives, and ensuring health carrier formulary compliance. The successful candidate will lead PBM audits and investigations, review drug formularies, and provide technical guidance to both internal staff and external stakeholders.
Duties and Tasks
Lead and manage audits and investigations of PBMs.
Ensure PBM compliance with state and federal laws, including Maximum Allowable Cost (MAC) pricing, rebate practices, retroactive fees, and consumer protection measures.
Recommend and enforce corrective actions when noncompliance is identified.
Evaluate health insurance formularies to ensure alignment with federal therapeutic class requirements.
Review prescription drug coverage and data submissions for compliance with Transparency in Coverage regulations.
Develop and refine standard operating procedures for formulary and data review.
Act as a liaison to stakeholders across the pharmaceutical and insurance industries.
Provide technical expertise to Division staff on complaints, appeals, legislative changes, and other pharmacy-related regulatory matters.
Assist with consumer appeals involving medication denials and formulary exceptions.
Minimum Qualifications
Education: Doctor of Pharmacy (PharmD) degree from a school or college of pharmacy recognized by the North Dakota Board of Pharmacy.
Licensure: Must hold an active North Dakota pharmacist license in good standing or be licensed in another state and obtain North Dakota license within 6 months of hire.
Knowledge and Skills
Understanding of state and federal pharmaceutical laws, and health insurance regulations.
Proficiency in analyzing formulary coverage and therapeutic drug classes.
Ability to interpret complex regulatory documents and apply them in practical settings.
Excellent written and verbal communication skills.
Strong research and reporting skills; capable of compiling and presenting findings effectively.
Effective time management and the ability to work both independently and collaboratively.
About Team ND \"Far and away the best prize life offers is the chance to work hard at work worth doing.\" - Theodore Roosevelt
More than 7,500 talented, hard-working people across sixty-three agencies have come together as Team North Dakota. At Team ND, we are driven to succeed through gratitude, humility, curiosity and courage. Our purpose is to empower people, improve lives, and inspire success. Join us in being legendary.
Total Rewards The State of North Dakota is committed to providing team members with a strong and competitive rewards package that supports you, your health and your family.
Considering a new position on Team ND? How does your current position stack up? Use the Total Rewards Calculator to estimate.
Application Procedures Applicants are screened based on qualifications, successful completion of the interview process and a background and criminal investigation. Applicants must be currently authorized to work in the United States on a full-time basis. The Insurance Department does not provide sponsorships.
Application package must be received by 11:59 PM Central Standard Time (CST) on the closing date listed on the opening.
TO BE CONSIDERED FOR THIS POSITION APPLICATIONS MUST BE SUBMITTED ONLINE AT: www.nd.gov/careers
Documents to be submitted:
Resume
Cover letter with a summary that clearly explains how the applicant's work experience is related to the summary of work and minimum/preferred qualifications.
3 Professional References
College Transcripts (copies or unofficial versions are acceptable for the initial application process but when the top candidate is given a conditional employment offer, they are required to present official transcripts)
Anyone needing assistance or accommodations during any part of the application or interview process please contact Rachel, E-mail: rkriege@nd.gov; phone: (701) 328-2931 or TTY: 1-800-366-6888.
The State of North Dakota and this hiring agency do not discriminate on the basis of race, color, national origin, sex (including sexual orientation and gender identity), genetics, religion, age or disability in employment or the provisions of services and complies with the provisions of the North Dakota Human Rights Act.
As an employer, the State of North Dakota prohibits smoking in all places of state employment in accordance with N.D.C.C. § 23-12-10.
Seniority Level Mid-Senior level
Employment Type Full-time
Job Function Quality Assurance, Health Care Provider, and Administrative
Industries Government Administration, Government Relations Services, and Insurance and Employee Benefit Funds
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Summary of Work We are seeking a highly knowledgeable and detail-oriented Pharmacy Benefits Management (PBM) Compliance Pharmacist to serve as a subject matter expert in PBMs. This position plays a critical role in enforcing PBM-related laws and regulations, supporting consumer protection initiatives, and ensuring health carrier formulary compliance. The successful candidate will lead PBM audits and investigations, review drug formularies, and provide technical guidance to both internal staff and external stakeholders.
Duties and Tasks
Lead and manage audits and investigations of PBMs.
Ensure PBM compliance with state and federal laws, including Maximum Allowable Cost (MAC) pricing, rebate practices, retroactive fees, and consumer protection measures.
Recommend and enforce corrective actions when noncompliance is identified.
Evaluate health insurance formularies to ensure alignment with federal therapeutic class requirements.
Review prescription drug coverage and data submissions for compliance with Transparency in Coverage regulations.
Develop and refine standard operating procedures for formulary and data review.
Act as a liaison to stakeholders across the pharmaceutical and insurance industries.
Provide technical expertise to Division staff on complaints, appeals, legislative changes, and other pharmacy-related regulatory matters.
Assist with consumer appeals involving medication denials and formulary exceptions.
Minimum Qualifications
Education: Doctor of Pharmacy (PharmD) degree from a school or college of pharmacy recognized by the North Dakota Board of Pharmacy.
Licensure: Must hold an active North Dakota pharmacist license in good standing or be licensed in another state and obtain North Dakota license within 6 months of hire.
Knowledge and Skills
Understanding of state and federal pharmaceutical laws, and health insurance regulations.
Proficiency in analyzing formulary coverage and therapeutic drug classes.
Ability to interpret complex regulatory documents and apply them in practical settings.
Excellent written and verbal communication skills.
Strong research and reporting skills; capable of compiling and presenting findings effectively.
Effective time management and the ability to work both independently and collaboratively.
About Team ND \"Far and away the best prize life offers is the chance to work hard at work worth doing.\" - Theodore Roosevelt
More than 7,500 talented, hard-working people across sixty-three agencies have come together as Team North Dakota. At Team ND, we are driven to succeed through gratitude, humility, curiosity and courage. Our purpose is to empower people, improve lives, and inspire success. Join us in being legendary.
Total Rewards The State of North Dakota is committed to providing team members with a strong and competitive rewards package that supports you, your health and your family.
Considering a new position on Team ND? How does your current position stack up? Use the Total Rewards Calculator to estimate.
Application Procedures Applicants are screened based on qualifications, successful completion of the interview process and a background and criminal investigation. Applicants must be currently authorized to work in the United States on a full-time basis. The Insurance Department does not provide sponsorships.
Application package must be received by 11:59 PM Central Standard Time (CST) on the closing date listed on the opening.
TO BE CONSIDERED FOR THIS POSITION APPLICATIONS MUST BE SUBMITTED ONLINE AT: www.nd.gov/careers
Documents to be submitted:
Resume
Cover letter with a summary that clearly explains how the applicant's work experience is related to the summary of work and minimum/preferred qualifications.
3 Professional References
College Transcripts (copies or unofficial versions are acceptable for the initial application process but when the top candidate is given a conditional employment offer, they are required to present official transcripts)
Anyone needing assistance or accommodations during any part of the application or interview process please contact Rachel, E-mail: rkriege@nd.gov; phone: (701) 328-2931 or TTY: 1-800-366-6888.
The State of North Dakota and this hiring agency do not discriminate on the basis of race, color, national origin, sex (including sexual orientation and gender identity), genetics, religion, age or disability in employment or the provisions of services and complies with the provisions of the North Dakota Human Rights Act.
As an employer, the State of North Dakota prohibits smoking in all places of state employment in accordance with N.D.C.C. § 23-12-10.
Seniority Level Mid-Senior level
Employment Type Full-time
Job Function Quality Assurance, Health Care Provider, and Administrative
Industries Government Administration, Government Relations Services, and Insurance and Employee Benefit Funds
#J-18808-Ljbffr