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

Responsibilities:

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.

Essential Functions:

• 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.

 
 

Experience:

• 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.

 
 

 
 

Clipped from: https://westcoast-jobs.com/jobs/oregon-medicaid-pbm-manager-idanha-oregon/297888584-2/?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic