Cynet systems Inc
PBM Business Integration Specialist (Pharmacist)
Cynet systems Inc, Raleigh, North Carolina, United States, 27601
Overview
Serve as a subject matter expert for the Pharmacy Business Unit within the Medicaid Enterprise System (MES) Program. Provide expertise and business support in the development and implementation of the Medicaid Enterprise Modular PBM Solution. Assist with onboarding the PBM vendor, serving as a business stakeholder and representing the Pharmacy Business Unit throughout implementation. Lead and provide guidance on Clinical policies and Prior Authorizations, Drug Utilization Review (DUR) and pharmacy lock-in processes, Behavioral Health and A+ Kids programs, Preferred Drug List (PDL) and Medicaid Drug Rebate Program (MDRP), and Physician Administered Drug Program (PADP).
Responsibilities
Collaborate with the Pharmacy Business team to define business process documents, business use cases, business case scenarios, and user acceptance test case scenarios.
Actively support cross-functional activities to provide oversight of Medicaid programs.
Communicate and collaborate with PBM business stakeholders, including Product Managers, Product Owners, and Business Leads.
Research, recommend, and assist in implementing business initiatives and product enhancements.
Provide input to senior-level decision-makers to develop long-range strategic alternatives for business solutions.
Ensure compliance with all applicable policies and procedures.
Support the product lifecycle from conception through implementation.
Perform other duties as assigned to support the successful development and implementation of the PBM Solution in alignment with Medicaid program goals.
Requirements / Must Have
In-depth knowledge of Medicaid Pharmacy Benefits Management processes and operational areas.
Experience with Medicaid applications and preferably across pharmacy functional areas.
Ability to translate business needs into detailed and actionable requirements.
Strong collaboration and communication skills to engage with business and IT stakeholders.
Experience supporting the full product lifecycle, from business requirements to functional specification and implementation.
Preferred / Nice to Have
Prior experience with Medicaid, managed care, and Pharmacy Benefit Manager (PBM) operations.
Knowledge of behavioral health programs and pediatric initiatives (A+ Kids).
Experience with Medicaid Drug Rebate Program (MDRP) and Preferred Drug List (PDL) processes.
Familiarity with physician-administered drug programs (PADP).
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Responsibilities
Collaborate with the Pharmacy Business team to define business process documents, business use cases, business case scenarios, and user acceptance test case scenarios.
Actively support cross-functional activities to provide oversight of Medicaid programs.
Communicate and collaborate with PBM business stakeholders, including Product Managers, Product Owners, and Business Leads.
Research, recommend, and assist in implementing business initiatives and product enhancements.
Provide input to senior-level decision-makers to develop long-range strategic alternatives for business solutions.
Ensure compliance with all applicable policies and procedures.
Support the product lifecycle from conception through implementation.
Perform other duties as assigned to support the successful development and implementation of the PBM Solution in alignment with Medicaid program goals.
Requirements / Must Have
In-depth knowledge of Medicaid Pharmacy Benefits Management processes and operational areas.
Experience with Medicaid applications and preferably across pharmacy functional areas.
Ability to translate business needs into detailed and actionable requirements.
Strong collaboration and communication skills to engage with business and IT stakeholders.
Experience supporting the full product lifecycle, from business requirements to functional specification and implementation.
Preferred / Nice to Have
Prior experience with Medicaid, managed care, and Pharmacy Benefit Manager (PBM) operations.
Knowledge of behavioral health programs and pediatric initiatives (A+ Kids).
Experience with Medicaid Drug Rebate Program (MDRP) and Preferred Drug List (PDL) processes.
Familiarity with physician-administered drug programs (PADP).
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