Manager, Pharmacy Benefit Management

Job Summary:

The Manager, Pharmacy Benefit Management is responsible for managing a team and overseeing the day-to-day operations associated with regulatory activity, PBM oversight, performance and monitoring, pharmacy audit activity, pharmacy compliance business owner tasks as well as supporting all new and existing market readiness activities.

Essential Functions:

• Manage all Pharmacy Regulatory activities including coordinating with internal and external partners to ensure accurate and timely delivery of documents for regulatory submissions
• Responsible for overseeing activities associated with maintaining oversight of the Pharmacy Benefit Manager including contract compliance monitoring, regulatory oversight, monitoring of delegated functions and state specific requirements
• Perform monitoring oversight review and engage cross functional partnership collaboration as needed
• Evaluation and oversight of current policies and procedures, ensure completeness, and assurance that there is compliance with all state/federal requirements
• Oversee all auditing activities associated with internal and external audits
• Manage all Pharmacy compliance and audit inbox inquiries and route appropriately for all pharmacy lines of business (LOB). Ensures appropriate and timely responses
• Ensures proper pharmacy expert representation is prepared and available for all external and internal audit conferences, inquiries, and readiness preparation
• Creation of appropriate supporting documentation to comply with evidentiary requirements for escalated findings/investigations in collaboration with Compliance team.
• Partner with cross functional partners on vendor/pharmacy related contractual issues, CAP management and performance guarantees
• Ensure accuracy and completeness of the pharmacy compliance dashboard
• Ensure market specific requirements are documented and tracked for appropriate reporting and compliance
• Manage Pharmacy compliance incidents escalated from intake and process investigations through resolution and manage corrective action plan and appropriate escalations.
• Manage tracking and monitoring of escalations, compliance memos, and reports received in shared mailboxes
• Manages team to ensure the management of oversight, performance, compliance, market readiness and other tasks/projects as assigned have successful execution, outcomes, continual improvement, and performance enhancements
• Perform any other job duties as requested

Education and Experience:

• Bachelor’s degree in business or related field, or equivalent years of relevant work experience is required
• Minimum of three (3) years of compliance and/or regulatory experience is required
• Three to five (3 to 5) years of pharmacy and/or Managed Care experience is required

Competencies, Knowledge, and Skills:

• Proven ability to effectively manage work and lead a team through prioritization, preparing, leveraging resources, and maintaining focus
• Demonstrated understanding of Compliance and Regulatory fundamentals specifically related to managed care and government programs (CMS/HHS/DOI/Medicaid)
• Proven knowledge of internal and external compliance, audit functions and procedures
• Ability to manage multiple complex and competing priorities with strong organizational and relationship building skills
• Ability to conduct research and analysis of Federal, State, and relevant industry regulatory and enforcement
• Excellent verbal and written communication skills
• Effective listening and demonstrated critical thinking skills
• Strong attention to detail, including work plan development and execution skills
• Strong interpersonal skills and high level of professionalism
• Strong skills with Microsoft Outlook
• Strong decision making and problem-solving skills 
• Ability to work independently and within a team environment
• Detail orientated with focus on maintaining accurate information in tools as required
• Ability to read and interpret complex information (such as audit findings, regulations and corrective action plans) required
• Negotiation skills/experience
• Time management skills including creation and maintenance of project timelines
• Advanced level experience in Microsoft Word, Excel, and PowerPoint

Licensure and Certification:

• None

Working Conditions:

• General office environment; may be required to sit or stand for extended periods of time

Compensation Range:

CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.

Compensation Type (hourly/salary):

Organization Level Competencies

• Fostering a Collaborative Workplace Culture

• Cultivate Partnerships

• Develop Self and Others

• Drive Execution

• Influence Others

• Pursue Personal Excellence

• Understand the Business