Market Regulation Consultant – Pharmacy Benefit Manager

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September 30

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RSM US LLP

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Consulting • Financial services • Professional services

RSM US LLP is a limited liability partnership and the U. S. member firm of RSM International, providing assurance, tax, and consulting services primarily to middle market businesses. The firm focuses on delivering insights and tailored solutions to help clients navigate complex business challenges and drive growth. With expertise across various sectors, RSM aims to support client success through strategic consulting and practical business solutions.

10,000+ employees

Founded 1926

📋 Description

• Assess PBM compliance with state and federal laws • Understand PBM operations in relation to the pharmaceutical supply chain • Evaluate PBM contracts with health plans and pharmacies to determine if they contain discriminatory or non-compliant provisions • Perform comparative reviews of MAC pricing lists/contracts • Conduct reimbursement methodology reviews, pharmacy audit reviews and network adequacy reviews • Validate and analyze the quarterly and annual data reports • Monitor PBM marketplace activities and trends • Document findings and reports of examinations in writing, as needed • Prepare and present training on such topics • Participate in practice development activities with state and federal state agencies

🎯 Requirements

• Must have 5+ years of PBM operational and/or compliance/internal audit experience • Prior consulting experience in healthcare, managed care, or PBM industries • Working knowledge of Pharmacy Benefit Managed Care business or PBM experience • Bachelor’s Degree in Business, Risk Management, Accounting, Finance or applicable fields • Must understand the fundamentals of the pharmaceutical supply chain, Maximum Allowable Cost (MAC) pricing, national average drug acquisition cost (NADAC) reimbursements, spread pricing, and pharmacy claims and balancing clinical, regulatory, pharmaceutical industry issues • Proficient at using Microsoft Office (Word, Excel, Access, PowerPoint, and Outlook) • Effective written and oral communication skills • Regulatory experience is a plus • Strong analytical abilities and attention to detail • Self-directed and the ability to problem solve in a positive, productive manner • Strong communication skills, collaborative, adaptable to changing priorities and ability to execute on tight deadlines • Must be comfortable doing presentations and conducting phone calls with multiple clients and team members • Travel as needed, minimal • Preferred IRES Designation such as Certified Insurance Examiner, Accredited Insurance Examiner or Market Conduct Management or a certified PBM designation • RSM does not intend to hire entry level candidates who will require sponsorship now OR in the future

🏖️ Benefits

• Competitive benefits and compensation package • Flexibility in your schedule, empowering you to balance life’s demands, while also maintaining your ability to serve clients • Individuals selected for this role will be eligible for a discretionary bonus based on firm and individual performance • Accommodation for applicants with disabilities is available upon request in connection with the recruitment process and/or employment/partnership • Learn more about our total rewards at https://rsmus.com/careers/working-at-rsm/benefits • Join our Talent Community