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PBM Business Integration Specialist
Jobs via Dice, Raleigh, North Carolina, United States, 27601
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Dice is the leading career destination for tech experts at every stage of their careers. Our client, UniMind Software Solutions, Inc., is seeking the following. Apply via Dice today!
PBM Business Integration Specialist 10 months
Raleigh, NC Hybrid
Our client seeks a Pharmacist as a Pharmacy Benefits Management (PBM) Business Integration Specialist to join the Medicaid Enterprise System (MES) project.
The PBM Business Integration Specialist will serve as a member of the DHHS Medicaid Enterprise System (MES) 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. This position may require interacting with the NC Medicaid Business Information Analytics Office, DHHS Data Office, Information Technology Division, Privacy and Security Office, Policy Office, General Counsel, Office of Procurement, Contracts and Grants, among others.
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
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 MES module will support the business requirements definition as well translation and specification of all functional requirements.
Seniority level
Entry level
Employment type
Full-time
Job function
Project Management and Information Technology
Industries
Software Development
#J-18808-Ljbffr
Dice is the leading career destination for tech experts at every stage of their careers. Our client, UniMind Software Solutions, Inc., is seeking the following. Apply via Dice today!
PBM Business Integration Specialist 10 months
Raleigh, NC Hybrid
Our client seeks a Pharmacist as a Pharmacy Benefits Management (PBM) Business Integration Specialist to join the Medicaid Enterprise System (MES) project.
The PBM Business Integration Specialist will serve as a member of the DHHS Medicaid Enterprise System (MES) 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. This position may require interacting with the NC Medicaid Business Information Analytics Office, DHHS Data Office, Information Technology Division, Privacy and Security Office, Policy Office, General Counsel, Office of Procurement, Contracts and Grants, among others.
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
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 MES module will support the business requirements definition as well translation and specification of all functional requirements.
Seniority level
Entry level
Employment type
Full-time
Job function
Project Management and Information Technology
Industries
Software Development
#J-18808-Ljbffr