Oregon Medicaid PBM Manager
Oregon Medicaid PBM Manager – Virtual
REMOTE – But must be in OREGON.
Full Time Permanent Opportunity
Must live in Oregon / some travel to Salem through the year
Manage the Client Pharmacy Team on the Oregon account to maintain all aspects of the PBM and Drug Rebate services for the State including:
- Maintaining an up-to-date drug reference file in the system
- Providing all aspects of pharmacy claim processing through the Client Pharmacy Services Module
- Coordinating a Prospective Drug Utilization Review program
- Operating a Federal Medicaid Drug Rebate Program as well as a State Supplemental Drug rebate program including oversight of 340B drug administration
- Overseeing the operation of a pharmacy, prior authorization, and technical call center for providers
- Overseeing the pharmacy and physician administered drug prior authorization review process and working with the other account pharmacists
- Assisting the state with pharmacy desk level audits using claim details from the system
- Providing ongoing training to pharmacy providers and State staff as needed
- Producing annual reports as well as other executive administration duties as they pertain to the State pharmacy program.
- Serve as the primary point of contact with the State Pharmacy Policy Director and State pharmacy staff including administration of scheduled status meetings.
- Primary liaison between the State Pharmacy Policy Director and the Client Pharmacy Team
- Oversight of all PBM and Drug Rebate services performed by Client in Oregon including supervision of the drug rebate and pharmacy call center teams.
- Responsible for working with State staff on Pharmacy-related issues, policy implementation, modernization, and program management.
- Responsible for making the final clinical decision on pharmacy issues referred to Client from the State.
- Oversee Prospective drug utilization review programs for the State including assisting the State in completing the annual CMS DUR Report.
- Oversee Drug Rebate team and operations management.
- Produce status reports on PBM Drug Rebate operations as required by State contract requirements.
- Work with Oregon account leadership to maintain all pharmacy related service level agreements and help achieve account financial and growth goals.
- At least three (3) years of experience in managing a pharmacy benefit management system.
- Detailed knowledge of Medicaid at the state and/or federal level.
- Detailed knowledge of pharmacy-related aspects of Medicaid.
- A bachelor’s degree in Pharmacy is required. PharmD preferred.
- A minimum of two (2) years’ experience in managing operational aspects in large-scale operations environment.
- Working knowledge of HIPAA regulations and requirements.
Knowledge, Skills, Abilities:
- Oregon licensed pharmacist required
- Ability to communicate succinctly and accurately in both written and verbal English.
- Ability to work independently and in a team environment.
- Ability to work effectively and efficiently under stringent timelines.
- Ability to analyze and resolve difficult logic and processing issues.
- Excellent organizational, written, and oral communication skills
- Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA)
- Proficient PC abilities (basic knowledge in MS Office), work organization, and problem resolution skills.