Enterprise Solutions, Inc.
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MES PBM Business Integration Specialist (Pharmacist)
NC, NC United States
Posted: 12/06/2023
2023-12-06
2024-05-17
Job Number: z5G7h3l6a1kMvyS65NP3c6ob72qGiUKCaQwFBZwxSbo=
Job Description
NC Department of Health and Human Services (DHHS) 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.
oClinical policies and Prior Authorizations.
oDrug Utilization Review (DUR) and pharmacy lock-in related processes
oBehavioral health, and A+ kids.
oPreferred Drug List (PDL) and Medicaid Drug Rebate Program (MDRP)
oPhysicians 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.
Education and Experience (Required):
•Graduation from an accredited School of Pharmacy
•B.S. or Doctor of Pharmacy degree required.
•Registered Pharmacist with a valid and unrestricted Pharmacist license
•3+ years of professional experience, preferably within a Medicaid agency or Pharmacy Benefit Manager (PBM)
•Understanding of pharmacy lines of business: retail, long term care, home infusion, mail order, specialty, institutional
•Drug information skills
•Analytical skills
•Computer proficiency with Microsoft Office (Word, Excel, PowerPoint) products
•Skills to handle multiple priorities and manage communications professionally to achieve issue resolution with customers, employees, or management.
License or Certification required by statue or regulation: (Is a license or certificate required? What kind and type?)
•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 of hire.
Required/Desired Skills
SkillRequired /DesiredAmountof ExperienceGraduation from an accredited School of Pharmacy, B.S. or Doctor of Pharmacy degreeRequired4YearsRegistered Pharmacist with a valid and unrestricted Pharmacist license Required3YearsLicensed to practice pharmacy in the State of North Carolina or the ability to receive the North Carolina license to practice Pharmacy within 90 days Required3YearsUnderstanding of pharmacy lines of business: retail, long term care, home infusion, mail order, specialty, institutionalRequired3YearsSkills to handle multiple priorities and manage communications professionally to achieve issue resolution with customers, employees, or managementRequired3YearsKnowledge of the Medicaid Pharmacy (PBM) processes, roles, and intended outcomes Required3YearsDrug information skillsRequired3YearsExperience in ensuring with all applicable policies and procedures. Required3YearsKnowledge of the Enterprise IT Systems integration principle and associated change management best practices Desired1YearsDemonstrate ability to manage multiple priorities and projects, and function in a fast passed moving constantly changing, deadline-driven environment Required3YearsProficient in Microsoft Word, Excel, PowerPoint, Access, and Adobe software Required3YearsExperience in reviewing and providing feedback and input to senior level decision-makers to develop long-range strategic alternatives for business solRequired3YearsExperience working in a combination of business analysis. Product management, project management, and or software application development Required3YearsExcellent communication skills and attention to detail with specific experience developing, editing, and presenting summaries, reports, and complex inRequired3YearsProven experience and working knowledge of the agile development methodologies, environment and tools Highly desired2YearsExperience handling HIPPA and PII data Required3YearsManaged care knowledge or experience Required3YearsMedicaid program knowledge or related Healthcare Information experience Required3Years
Questions
No.QuestionQuestion1Absences greater than two weeks MUST be approved by CAI management in advance, and contact information must be provided to CAI so that the resource can be reached during his or her absence. The Client has the right to dismiss the resource if he or she does not return to work by the agreed upon date. Do you accept this requirement?Question2All work must be completed on-site. Do you accept this requirement?Question3Candidate must be able to attend an webcam interview. Do you accept this requirement?Question4Please list candidate’s email address. Question5Please indicate how soon this candidate is available to start work. Vendors are encouraged to submit candidates that are available for the duration of the assignment.Question6Vendor must disclose to the agency if the candidate will be subcontracted at the time of submission. Do you accept this requirement?Question7Vendor must notify the agency if any portion of the requirements listed in this task order is to be outsourced to other countries. Do you accept this requirement?Question8Candidates submitted above the rate of xxxx will not be considered. Do you accept this requirement? Question9Payment for all approved hours will be paid at the straight hourly rate regardless of the total hours worked by the engaged resource. It is the responsibility of the supplier to adhere to any applicable compensation laws including payment for overtime hours. Do you accept this requirement?Question10Please confirm you have thoroughly validated, and attest to the accuracy of, the credentials listed throughout this candidate’s VectorVMS profile and resume pursuant to Section 5.2.5 of ITS-009440. Do you confirm?
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.
oClinical policies and Prior Authorizations.
oDrug Utilization Review (DUR) and pharmacy lock-in related processes
oBehavioral health, and A+ kids.
oPreferred Drug List (PDL) and Medicaid Drug Rebate Program (MDRP)
oPhysicians 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.
Education and Experience (Required):
•Graduation from an accredited School of Pharmacy
•B.S. or Doctor of Pharmacy degree required.
•Registered Pharmacist with a valid and unrestricted Pharmacist license
•3+ years of professional experience, preferably within a Medicaid agency or Pharmacy Benefit Manager (PBM)
•Understanding of pharmacy lines of business: retail, long term care, home infusion, mail order, specialty, institutional
•Drug information skills
•Analytical skills
•Computer proficiency with Microsoft Office (Word, Excel, PowerPoint) products
•Skills to handle multiple priorities and manage communications professionally to achieve issue resolution with customers, employees, or management.
License or Certification required by statue or regulation: (Is a license or certificate required? What kind and type?)
•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 of hire.
Required/Desired Skills
SkillRequired /DesiredAmountof ExperienceGraduation from an accredited School of Pharmacy, B.S. or Doctor of Pharmacy degreeRequired4YearsRegistered Pharmacist with a valid and unrestricted Pharmacist license Required3YearsLicensed to practice pharmacy in the State of North Carolina or the ability to receive the North Carolina license to practice Pharmacy within 90 days Required3YearsUnderstanding of pharmacy lines of business: retail, long term care, home infusion, mail order, specialty, institutionalRequired3YearsSkills to handle multiple priorities and manage communications professionally to achieve issue resolution with customers, employees, or managementRequired3YearsKnowledge of the Medicaid Pharmacy (PBM) processes, roles, and intended outcomes Required3YearsDrug information skillsRequired3YearsExperience in ensuring with all applicable policies and procedures. Required3YearsKnowledge of the Enterprise IT Systems integration principle and associated change management best practices Desired1YearsDemonstrate ability to manage multiple priorities and projects, and function in a fast passed moving constantly changing, deadline-driven environment Required3YearsProficient in Microsoft Word, Excel, PowerPoint, Access, and Adobe software Required3YearsExperience in reviewing and providing feedback and input to senior level decision-makers to develop long-range strategic alternatives for business solRequired3YearsExperience working in a combination of business analysis. Product management, project management, and or software application development Required3YearsExcellent communication skills and attention to detail with specific experience developing, editing, and presenting summaries, reports, and complex inRequired3YearsProven experience and working knowledge of the agile development methodologies, environment and tools Highly desired2YearsExperience handling HIPPA and PII data Required3YearsManaged care knowledge or experience Required3YearsMedicaid program knowledge or related Healthcare Information experience Required3Years
Questions
No.QuestionQuestion1Absences greater than two weeks MUST be approved by CAI management in advance, and contact information must be provided to CAI so that the resource can be reached during his or her absence. The Client has the right to dismiss the resource if he or she does not return to work by the agreed upon date. Do you accept this requirement?Question2All work must be completed on-site. Do you accept this requirement?Question3Candidate must be able to attend an webcam interview. Do you accept this requirement?Question4Please list candidate’s email address. Question5Please indicate how soon this candidate is available to start work. Vendors are encouraged to submit candidates that are available for the duration of the assignment.Question6Vendor must disclose to the agency if the candidate will be subcontracted at the time of submission. Do you accept this requirement?Question7Vendor must notify the agency if any portion of the requirements listed in this task order is to be outsourced to other countries. Do you accept this requirement?Question8Candidates submitted above the rate of xxxx will not be considered. Do you accept this requirement? Question9Payment for all approved hours will be paid at the straight hourly rate regardless of the total hours worked by the engaged resource. It is the responsibility of the supplier to adhere to any applicable compensation laws including payment for overtime hours. Do you accept this requirement?Question10Please confirm you have thoroughly validated, and attest to the accuracy of, the credentials listed throughout this candidate’s VectorVMS profile and resume pursuant to Section 5.2.5 of ITS-009440. Do you confirm?