Manager, Pharmacy Benefit Management

Job not on LinkedIn

🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $94.1k - $164.8k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

💊 Pharmacist

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CareSource

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 30+ years

⚕️ Healthcare Insurance

Healthcare Insurance

CareSource is a health services company focused on providing affordable health insurance and healthcare solutions. It offers a wide range of plans including Medicaid, Marketplace, and Medicare Advantage, targeting low-income adults, families, children, pregnant women, elderly adults, and people with disabilities. Additionally, CareSource provides members with resources for COVID-19 support, dental, vision, and hearing benefits, as well as pharmacy services. The company emphasizes easy access to healthcare management through online platforms and a mobile app.

📋 Description

• Manage all Pharmacy Regulatory activities including coordinating with internal and external partners to ensure accurate and timely delivery of documents for regulatory submissions • Responsible for overseeing activities associated with maintaining oversight of the Pharmacy Benefit Manager including contract compliance monitoring, regulatory oversight, monitoring of delegated functions and state specific requirements • Perform monitoring oversight review and engage cross functional partnership collaboration as needed • Evaluation and oversight of current policies and procedures, ensure completeness, and assurance that there is compliance with all state/federal requirements • Oversee all auditing activities associated with internal and external audits • Manage all Pharmacy compliance and audit inbox inquiries and route appropriately for all pharmacy lines of business (LOB). Ensures appropriate and timely responses • Ensures proper pharmacy expert representation is prepared and available for all external and internal audit conferences, inquiries, and readiness preparation • Creation of appropriate supporting documentation to comply with evidentiary requirements for escalated findings/investigations in collaboration with Compliance team. • Partner with cross functional partners on vendor/pharmacy related contractual issues, CAP management and performance guarantees • Ensure accuracy and completeness of the pharmacy compliance dashboard • Ensure market specific requirements are documented and tracked for appropriate reporting and compliance • Manage Pharmacy compliance incidents escalated from intake and process investigations through resolution and manage corrective action plan and appropriate escalations. • Manage tracking and monitoring of escalations, compliance memos, and reports received in shared mailboxes • Manages team to ensure the management of oversight, performance, compliance, market readiness and other tasks/projects as assigned have successful execution, outcomes, continual improvement, and performance enhancements • Perform any other job duties as requested

🎯 Requirements

• Bachelor’s degree in business or related field, or equivalent years of relevant work experience is required • Minimum of three (3) years of compliance and/or regulatory experience is required • Three to five (3 to 5) years of pharmacy and/or Managed Care experience is required • Proven ability to effectively manage work and lead a team through prioritization, preparing, leveraging resources, and maintaining focus • Demonstrated understanding of Compliance and Regulatory fundamentals specifically related to managed care and government programs (CMS/HHS/DOI/Medicaid) • Proven knowledge of internal and external compliance, audit functions and procedures • Ability to manage multiple complex and competing priorities with strong organizational and relationship building skills • Ability to conduct research and analysis of Federal, State, and relevant industry regulatory and enforcement • Excellent verbal and written communication skills • Effective listening and demonstrated critical thinking skills • Strong attention to detail, including work plan development and execution skills • Strong interpersonal skills and high level of professionalism • Strong skills with Microsoft Outlook • Strong decision making and problem-solving skills • Ability to work independently and within a team environment • Detail orientated with focus on maintaining accurate information in tools as required • Ability to read and interpret complex information (such as audit findings, regulations and corrective action plans) required • Negotiation skills/experience • Time management skills including creation and maintenance of project timelines • Advanced level experience in Microsoft Word, Excel, and PowerPoint.

🏖️ Benefits

• substantial and comprehensive total rewards package • bonuses tied to company and individual performance