Roles and Responsibilities
• Supports one or more Pharmacy business process areas, including.
o Clinical policies and Prior Authorizations.
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.

Required/Desired Skills

Skill

Required /Desired

Amount

of Experience

Graduation from an accredited School of Pharmacy, B.S. or Doctor of Pharmacy degree

Required

0

Registered Pharmacist with a valid (active) and unrestricted Pharmacist license

Required

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

Required

0

Understanding of pharmacy lines of business: retail, long term care, home infusion, mail order, specialty, institutional

Required

3

Years

Skills to handle multiple priorities and manage communications professionally to achieve issue resolution with customers, employees, or management

Required

3

Years

Knowledge of the Medicaid Pharmacy (PBM) processes, roles, and intended outcomes

Required

3

Years

Drug information skills

Required

3

Years

Experience in ensuring with all applicable policies and procedures.

Required

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

Required

3

Years

Proficient in Microsoft Word, Excel, PowerPoint, Access, and Adobe software

Required

3

Years

Experience in reviewing and providing feedback and input to senior level decision-makers to develop long-range strategic alternatives for business sol

Required

3

Years

Experience working in a combination of business analysis. Product management, project management, and or software application development

Required

3

Years

Excellent communication skills and attention to detail with specific experience developing, editing, and presenting summaries, reports, and complex in

Required

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

Required

3

Years

Managed care knowledge or experience

Required

3

Years

Medicaid program knowledge or related Healthcare Information experience

Required

3

Years