NCDHHS-HB - PBM Business Integration Specialist (Pharmacist)

NC Department of Health and Human Services (DHHS) seeks a Pharmacist as a Pharmacy Benefits Management (PBM) Business Integration Specialist to join the Medicaid Enterprise System (MES) project.

The PBM Business Integration Specialist will serve as a member of the DHHS Medicaid Enterprise System (MES) Program within Pharmacy Business space. The PBM Business Integration Specialist will provide expertise and business support to the Pharmacy and Ancillary Services Business Unit in the development and implementation of the Medicaid Enterprise Modular Pharmacy Business Management (PBM) Solution. The PBM Business Integration Specialist, as a Business Subject Matter Expert, will assist the Department to on-board the PBM vendor, serve as a business stakeholder, and represent the Pharmacy Business Unit in the implementation of the complex and innovative PBM Solution.

The primary responsibility of this position is to serve as the subject matter expert and content lead in collaboration with the Pharmacy Business team for Clinical policies and Prior Authorizations, Drug Utilization Review (DUR) and pharmacy lock-in related processes, Behavioral health, and A+ kids, Preferred Drug List (PDL) and Medicaid Drug Rebate Program (MDRP), and Physicians Administered Drug Program (PADP) related to the Medicaid Drug Rebate Program (MDRP).

The Pharmacy team needs a Business Integration Specialist who is dedicated to the PBM Module Implementation and can focus on these work streams as they relate to implementation of the new PBM, in collaboration with the existing pharmacy team.

Knowledge of Medicaid Pharmacy Benefits Management processes, intended outcomes, and pain points is essential.

This position will actively work with the Pharmacy Business team to define and provide the business support in completing the business process documents, Business use cases, Business case scenarios, user acceptance test case scenarios, and documentation in relation to Medicaid initiatives and strategic goals. This position may require interacting with the NC Medicaid Business Information Analytics Office, DHHS Data Office, Information Technology Division, Privacy and Security Office, Policy Office, General Counsel, Office of Procurement, Contracts and Grants, among others.

Roles and Responsibilities

Supports one or more Pharmacy business process areas, including.

o Clinical policies and Prior Authorizations.

o Drug Utilization Review (DUR) and pharmacy lock-in related processes

o Behavioral health, and A+ kids.

o Preferred Drug List (PDL) and Medicaid Drug Rebate Program (MDRP)

o Physicians Administered Drug Program (PADP) related to the Medicaid Drug Rebate Program (MDRP)

Supports cross-functional activities that provide effective oversight of Medicaid Programs.

Collaborates and communicates with the PBM Business stakeholders (Product Managers, Product Owners, Business Leads.)

In-depth knowledge and understanding of the business needs across functions and business segments in healthcare that meet departmental goals.

Ability to research and recommend the development and implementation of business initiatives of the product enhancements.

Provides feedback and input to senior level decision-makers to develop long-range strategic alternatives for business solutions.

Preferred to have experience with Medicaid, managed care, and Pharmacy Benefit Manager (PBM) operations. areas.

Prior experience with Medicaid applications and preferably across Pharmacy Functional Areas.

Communicate with the business owner needs and help translate them into detailed and actionable requirements as needed.

Ensures compliance with all applicable policies and procedures.

Supporting the product lifecycle from conception through implementation.

Performs other duties as assigned.

In addition, the Pharmacy Business Integration Specialist is responsible in supporting the Business Management space to achieve successful development of the Pharmacy Benefit Management Solution in support of the Medicaid program. The Business Integration Specialist will work collaboratively with the Business owner and the rest of the business team to develop the strategy behind how each MES module will support the business requirements definition as well translation and specification of all functional requirements.

Required / Desired Skills

Skill

Required / Desired

Amount

of Experience

Graduation from an accredited School of Pharmacy, B.S. or Doctor of Pharmacy degree

Required

Registered Pharmacist with a valid (active) and unrestricted Pharmacist license

Required

Years

Licensed to practice pharmacy in the State of North Carolina or the ability to receive the North Carolina license to practice Pharmacy within 90 days

Required

Understanding of pharmacy lines of business : retail, long term care, home infusion, mail order, specialty, institutional

Required

Years

Skills to handle multiple priorities and manage communications professionally to achieve issue resolution with customers, employees, or management

Required

Years

Knowledge of the Medicaid Pharmacy (PBM) processes, roles, and intended outcomes

Required

Years

Drug information skills

Required

Years

Experience in ensuring with all applicable policies and procedures.

Required

Years

Knowledge of the Enterprise IT Systems integration principle and associated change management best practices

Desired

Years

Demonstrate ability to manage multiple priorities and projects, and function in a fast passed moving constantly changing, deadline-driven environment

Required

Years

Proficient in Microsoft Word, Excel, PowerPoint, Access, and Adobe software

Required

Years

Experience in reviewing and providing feedback and input to senior level decision-makers to develop long-range strategic alternatives for business sol

Required

Years

Experience working in a combination of business analysis. Product management, project management, and or software application development

Required

Years

Excellent communication skills and attention to detail with specific experience developing, editing, and presenting summaries, reports, and complex in

Required

Years

Proven experience and working knowledge of the agile development methodologies, environment and tools

Highly desired

Years

Experience handling HIPPA and PII data

Required

Years

Managed care knowledge or experience

Required

Years

Medicaid program knowledge or related Healthcare Information experience

Required

Years

Questions

Question

Question1

Absences greater than two weeks MUST be approved by CAI management in advance, and contact information must be provided to CAI so that the resource can be reached during his or her absence. The Client has the right to dismiss the resource if he or she does not return to work by the agreed upon date. Do you accept this requirement?

Question2

This posting is preferred as Hybrid but remote is available as long as previously discussed,

Question3

Candidate must be able to attend webcam interview. Do you accept this requirement?

Question4

Please list candidate s email address.

Question5

Please indicate how soon this candidate is available to start work. Vendors are encouraged to submit candidates that are available for the duration of the assignment.

Question6

Vendor must disclose to the agency if the candidate will be subcontracted at the time of submission. Do you accept this requirement?

Question7

Vendor must notify the agency if any portion of the requirements listed in this task order is to be outsourced to other countries. Do you accept this requirement?

Question8

Candidates submitted above the rate of -5 will not be considered. Do you accept this requirement?

Question9

Payment for all approved hours will be paid at the straight hourly rate regardless of the total hours worked by the engaged resource. It is the responsibility of the supplier to adhere to any applicable compensation laws including payment for overtime hours. Do you accept this requirement?

Question10

Please confirm you have thoroughly validated, and attest to the accuracy of, the credentials listed throughout this candidate s VectorVMS profile and resume pursuant to Section 5.2.5 of ITS-009440. Do you confirm?

Question11

Vendors will be required to submit a copy of their candidates pharmacy license.