CRM Administrator

Responsibilities:

• Supports one or more pharmacy business process areas, including:

  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).
• 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 PBM business stakeholders, including product managers, product owners, and business leads.
• Demonstrates in-depth knowledge and understanding of business needs across healthcare functions and segments to meet departmental goals.
• Researches and recommends the development and implementation of business initiatives or product enhancements.
• Provides feedback and input to senior-level decision-makers to support development of long-range strategic alternatives for business solutions.
• Preferred to have experience with Medicaid, managed care, and Pharmacy Benefit Manager (PBM) operations.
• Experience with Medicaid applications, preferably across pharmacy functional areas.
• Communicates with business owners to understand needs and translates them into detailed and actionable requirements.
• Ensures compliance with all applicable policies and procedures.
• Supports the product lifecycle from conception through implementation.
• Performs other duties as assigned.

• Supports the Business Management function to achieve successful development of the Pharmacy Benefit Management solution for the Medicaid program.
• Collaborates with the business owner and business team to develop the strategy behind how each MES module will support business requirements.
• Responsible for translating and specifying all functional requirements to ensure alignment with business needs.