MES PBM Business Integration Specialist

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Position : MES PBM Business Integration Specialist (724002)

Location : Raleigh, NC

Duration : Long Term

Client : State of NC

Job ID : 724002

Job Description :

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 Product Integration Specialist will serve as a member of the DHHS Medicaid Enterprise System (MES) Program within the Product Management space. This position will support the product manager to champion our department's key strategies with the goal of creating the opportunity for healthier outcomes for our citizens through clinical and technological innovation. This position is responsible for supporting independent product oversight for NCDHHS Medicaid, specifically the Pharmacy Benefits Management (PBM). Expert knowledge of Medicaid Pharmacy Benefits Management processes, intended outcomes, and pain points is essential. This oversight may include development and monitoring of the Medicaid Managed Care product strategies, while collaborating with other DHHS divisions and external stakeholders to develop and implement targeted strategies to streamline processes. This position will actively work with the Pharmacy Business to develop the business process documents, create user stories, business case scenarios, identify user acceptance test case scenarios, research, and document in relation to Medicaid initiatives and strategic goals. The Product Integration Specialist goes hand in hand for the Product Manager and Core Business team and represents DHHS business functions within NC Medicaid and functions within the Product Management Space. This position sometimes 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.

• Supports cross-functional activities that provide effective oversight of Medicaid Programs.
• Works closely with the Product Manager in achieving direct and hybrid reporting relationships and staff, sets priorities, establishes accountabilities, and defines roles / responsibilities to secure necessary resources not under direct supervision, while maintaining peak levels of performance and compliance.
• Collaborates and communicates with workgroups around product deliverables with Product Managers, Product Owners, Business Leads.
• In-depth knowledge and understanding of products across functions and business segments in healthcare that meet departmental goals.
• Ability to research and recommend the development and implementation of new product initiatives, including current product enhancements.
• Provides feedback and input to senior level decision-makers to develop long-range strategic alternatives for product solutions.
• Must have experience with Medicaid / Health Care and / or Managed Care areas.
• Good understanding of CMS MITA Framework across Medicaid Business Architecture, Information Architecture and Technical Architecture initiatives and activities.
• Prior experience with Medicaid applications and preferably across Pharmacy Functional Areas.
• Through a variety of communication / meeting methods, confirm the business owner needs and help translate them into detailed and actionable requirements as needed.
• Provide in-person, conference calls, or virtual training on product knowledge, usage, and implementation.
• Able to document database queries to analyze performance indicators, evaluate survey data, define successful criteria for testing and product acceptance.
• Ensures compliance with all applicable policies and procedures.
• Supporting the product lifecycle from conception through implementation.
• Able to assess emerging products and partners to measure and address their potential value or risk to the department, as well as make recommendations on which modern technologies to invest in or leverage.
• Adhere to the Product Management guidelines.
• Research and gather the information needed for the Product to evaluate and analyze the work done by Medicaid SMEs, Business and Technical Leads, Data Leads, Engineers, and Architects to ensure the business requested capability, implemented design, and delivered functionality is successful and useful to the stakeholders.
• Familiarity with CMS Certification process
• Performs other duties as assigned.

In addition, the Product Integration Specialist is responsible for supporting the Product Management space to achieve successful development of IT systems in support of the Medicaid program. The Product Integration Specialist will actively work with the Product Manager in expressly engage with the business owners to develop the strategy behind how each MES module will support the business requirements definition and will own the translation and specification of all functional requirements. This position will work integrally with MES Product Managers and the Business core to support maintaining and managing all the vendor deliverables, artifacts, help to manage the launch of features and systems.

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

Required

Years

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

Required

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 Project, Word, Excel, PowerPoint, Access, and Adobe software

Required

Years

Skills in persuasion, negotiation, relationship management, conflict resolution, and effective oral and written communication at all levels

Required

Years

Previous experience creating business use cases, requirements, and process maps / data floes

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 using or implementing Cloud technologies Iaas, Paas, Saas

Highly desired

Years

Experience handling HIPPA and PII data

Required

Years

Ability to gather data via diverse means (i.e., interviews, observation, surveys, existing written documentation) and interpret relevant information

Highly desired

Years

Managed care knowledge or experience

Required

Years

MITA knowledge and understanding of the CMS's Seven Standards and conditions

Required

Years

Medicaid program knowledge or related Healthcare Information experience