PBM Business Integration Specialist (Pharmacist) (Hybrid)
PBM Business Integration Specialist (Pharmacist) (Hybrid)
Posted on :
26-06-2025
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Job Description
Job Title: PBM Business Integration Specialist (Pharmacist) (Hybrid)
Location: Raleigh NC
Duration: 12 Months
Job Description:
The 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 client 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).
Roles and Responsibilities
o Drug Utilization Review (DUR) and pharmacy lock-in related processes
o Behavioral health and A kids.
o Preferred Drug List (PDL) and Medicaid Drug Rebate Program (MDRP)
o Physicians Administered Drug Program (PADP) related to the Medicaid Drug Rebate Program (MDRP)
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.
Skills:
Skill Required/Desired Amount of Experience Graduation from an accredited School of Pharmacy B.S. or Doctor of Pharmacy degree Registered Pharmacist with a valid (active) and unrestricted Pharmacist license 3 Years Licensed to practice pharmacy in the State of North Carolina or the ability to receive the North Carolina license to practice Pharmacy within 90 days Understanding of pharmacy lines of business: retail long term care home infusion mail order specialty institutional 3 Years Skills to handle multiple priorities and manage communications professionally to achieve issue resolution with customers employees or management 3 Years Knowledge of the Medicaid Pharmacy (PBM) processes roles and intended outcomes 3 Years Drug information skills 3 Years Experience in ensuring with all applicable policies and procedures. 3 Years Knowledge of the Enterprise IT Systems integration principle and associated change management best practices Desired 1 Years Demonstrate ability to manage multiple priorities and projects and function in a fast passed moving constantly changing deadline-driven environment 3 Years Proficient in Microsoft Word Excel PowerPoint Access and Adobe software 3 Years Experience in reviewing and providing feedback and input to senior level decision-makers to develop long-range strategic alternatives for business sol 3 Years Experience working in a combination of business analysis. Product management project management and or software application development 3 Years Excellent communication skills and attention to detail with specific experience developing editing and presenting summaries reports and complex in 3 Years Proven experience and working knowledge of the agile development methodologies environment and tools Highly desired 2 Years Experience handling HIPPA and PII data 3 Years Managed care knowledge or experience 3 Years Medicaid program knowledge or related Healthcare Information experience 3 Years
Location: Raleigh NC
Duration: 12 Months
Job Description:
The 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 client 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 client Data Office client 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.
o Drug Utilization Review (DUR) and pharmacy lock-in related processes
o Behavioral health and A kids.
o Preferred Drug List (PDL) and Medicaid Drug Rebate Program (MDRP)
o 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. areas.
- 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.
Skills:
Required Experience:
Senior IC
Employment Type
Contract
Key Skills
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