The PBM Business Integration Specialist (Pharmacist) will serve as a subject matter expert within the Pharmacy Business space, supporting the development and implementation of a Medicaid Enterprise Modular Pharmacy Business Management (PBM) Solution. This role involves collaborating with stakeholders, defining business requirements, and ensuring compliance with policies and procedures related to Medicaid pharmacy benefits.
Location:Raleigh, North Carolina, United States\nWashington, District of Columbia, United States
Responsibilities:
- Supports pharmacy business process areas, including clinical policies, prior authorizations, drug utilization review, pharmacy lock-in, behavioral health programs, preferred drug lists, and physician-administered drug programs.
- Supports cross-functional activities for effective oversight of Medicaid Programs.
- Collaborates and communicates with PBM Business stakeholders.
- Researches and recommends the development and implementation of business initiatives and product enhancements.
- Provides feedback to senior-level decision-makers for strategic business solutions.
- Translates business owner needs into detailed and actionable requirements.
- Ensures compliance with all applicable policies and procedures.
- Supports the product lifecycle from conception through implementation.
- Performs other duties as assigned.
- Develops business process documents, use cases, scenarios, and user acceptance test cases.
Required Skills & Certifications:
Preferred Skills & Certifications:
Special Considerations:
Scheduling:
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