Manager - Pharmacy Benefits Regulatory Operations

April 22

🏖️ New Jersey – Remote

Although this job is listed in New Jersey, this company may be open to hiring remote in other states.

⏰ Full Time

🟡 Mid-level

🟠 Senior

🚔 Compliance

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ExactCare

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ExactCare is a leading pharmacy care management provider that specializes in medication management for individuals with complex, chronic medical needs. With operations in all 50 states and Washington, D. C. , ExactCare supports more than 100,000 people nationwide, helping them manage their medications in assisted living, long-term care facilities, and at home. Partnering with healthcare organizations, ExactCare aims to improve clinical outcomes by ensuring better medication adherence, reducing readmissions, and lowering overall healthcare costs.

Chronic Care Pharmacy-at-Home • Medication Management for High-Risk Patients • Medication Therapy Management • Gaps in Care • STAR Ratings Adherence Improvement

501 - 1000 employees

Founded 2009

⚕️ Healthcare Insurance

💊 Pharmaceuticals

💰 Private Equity Round on 2016-03

📋 Description

• Responsible for regulatory oversight of Pharmastar. • Assists with various internal tasks that ensure a high level of overall client compliance and satisfaction. • Ensures Pharmastar is appropriately licensed based on services rendered. • Tracks state and federal business requirements and manages compliance with regulatory reporting. • Contacts regulators for clarification and guidance. • Manages regulatory audit proceedings. • Coordinates pharmacy audits and distributes plan specific audit result letters. • Participates in clients’ CMS financial audits providing documentation and reports as needed. • Researches regulatory issues related to clients’ drug benefits and reports results to clients. • Develops Corrective Action Plans (CAPs) in response to audit findings. • Monitors Medicare Part D regulation and guidance for applicability to Pharmastar. • Assists with facilitating client awareness of regulatory changes. • Responsible for maintaining policies and procedures related to regulatory compliance.

🎯 Requirements

• Associate's degree or related experience. • Minimum of 5 years of healthcare experience. • Knowledge of Medicare Part D Plan and/or PACE Administration. • Experience in PBM or pharmacy support role. • Current on plan and benefit structures and Medicare guidelines. • Drives a strong culture of owning problem solving and accountability. • A forward-thinking personality capable of identifying areas for improvement. • Outstanding written and verbal communication skills with clarity of thought. • Skilled in establishing and maintaining effective working relationships. • Skilled in problem resolution; recommends suggestions to increase accuracy and/or efficiency. • Ability to continuously display personal integrity and exemplary ethical standards. • Tolerance for, and the ability to perform well, in stressful and ambiguous situations. • Ability and flexibility to work in a relatively unstructured environment. • Maintains safe working environment. • Strong computer skills including using word processors, spreadsheets, and database software.

🏖️ Benefits

• medical/dental/vision • flexible spending • company-paid life insurance • short-term disability • voluntary benefits • 401(k) • Paid Time Off • paid holidays