Pharmacy Benefits Administrator Consultant
Pharmacy Benefits Administrator Consultant
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USD 144000 - 205000
1 Vacancy
Job Description
Description
- Providing consultation regarding policy formulation and oversight for all aspects of MediCals pharmacy medical supply and enteral nutrition benefits (MediCal Rx) including state supplemental drug rebate negotiations and the federal drug rebate program.
- Assisting with Medicaid drug program policies and procedures providing expert policy guidance and consultation on all Medicaid pharmaceutical matters.
- Developing interpreting evaluating and implementing highly complex and sensitive pharmacy policy and legislative regulatory language.
- Creating and maintaining a list of covered (formulary) with different tiers based on cost and therapeutic value influencing which medications patients can access and at what price.
- Negotiating discounts and rebates with drug manufacturers to secure the best prices for health plans.
- Establishing a network of pharmacies where patients can access prescriptions at negotiated rates.
- Reviewing and processing prescription drug claims submitted by pharmacies determining patient copays and reimbursing pharmacies.
- Implementing prior authorization step therapy and quantity limits to ensure appropriate medication usage and cost control.
- Monitoring prescription drug trends and utilization patterns to identify areas for cost optimization.
- Managing formularies and promoting appropriate medication usage to ensure patients have access to necessary medications while controlling costs.
- Performing other related duties as assigned.
- Ability to negotiate with drug manufacturers healthcare plan providers and retail pharmacies to establish fair pricing strategies.
- Proficiency in collecting assessing and analyzing data to conclude solve problems and recommend pricing options.
- Strong ability to evaluate diverse factors such as economic trends business strategies and public health needs to ensure accurate and fair pricing.
- Excellent verbal and written communication to collaborate effectively with corporate leaders retail managers and insurance providers ensuring alignment and workable solutions.
- PharmD or Bachelors degree in healthcare pharmacy information systems or a related field. (Mandatory)
- 3 years of experience as a pharmacy benefits manager or administrator including experience with formulary management. (Mandatory)
- Experience with pharmacy benefit management software and systems. (Preferred)
- Knowledge of state and federal regulations related to pharmacy benefits. (Preferred)
- Certification in pharmacy or healthcarerelated fields (e.g. CPhT CPC). (Preferred)
Contract
Employment Type
Full Time
Key Skills
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