PBM Business Integration Specialist (Pharmacist)

Overview

On Site
Depends on Experience
Accepts corp to corp applications
Contract - W2
Contract - 9 Month(s)

Skills

Acceptance Testing
Benefits Management
Business Cases
Business Process
Collaboration

Job Details

We are looking for PBM Business Integration Specialist (Pharmacist) for our client in Raleigh, NC
Job Title: PBM Business Integration Specialist (Pharmacist)
Job Location: Raleigh, NC
Job Type: Contract
Job Description:
  • 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).
  • 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.
Requirement/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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