Manager - Pharmacy Benefits Regulatory Operations

Job not on LinkedIn

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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Healthcare Insurance • Pharmaceuticals

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.

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