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Part-Time/Project-Based Senior Consultant: Health Plan Services (Part D)

Location: Rolling Meadows, Illinois (Remote)

Introduction
Discover a world of endless possibilities at Gallagher Benefit Services, where you’ll have the power to shape the future of workplaces across industries. As a member of our team, you become the driving force behind positive change, helping clients build environments where employees thrive. Embrace the opportunity to impact lives, unlock potential, and create a legacy of remarkable transformation.We believe that every candidate brings something special to the table, including you! So, even if you feel that you’re close but not an exact match, we encourage you to apply.

Overview
BluePeak Advisors, a division of Gallagher Benefit Services, Inc., leads the nation in healthcare compliance consulting that focuses on government programs including Medicare Parts C and D, Medicaid, and Exchanges. We assist health plans, pharmacy benefit management (PBM) companies allied health companies and pharmaceutical manufacturers with regulatory, operational and compliance issues.

How you’ll make an impact
The Part-Time/Project-Based Senior Consultant Part D is a subject matter expert on the BluePeak Pharmacy Consulting team. This position provides ongoing client consulting, audit subject matter expertise and technical support for Medicare and other government sponsored health plans and vendors.

• Subject matter expertise in an operational function of Medicare Part D such as Formulary Administration and/or Coverage Determinations, Appeals and Grievances.
•  Ability to review, interpret and implement state and federal guidance
• Ability to review claims and claims logic, identify and remediate issues and potential issues.
• Familiarity with CMS Program Audit process in Formulary Administration and Coverage Determinations, Appeals and Grievances.
• Monitor the implementation of pharmacy related corrective action plans and ensures that the results of the action plans are compliant.
• Mentor and drive work product based on the project management lifecycle.
• Oversee and administer ongoing monitoring program(s) based on guidance.
• Develop and update policies, procedures and Auditing and Monitoring Work Plan as needed.
• Communicate with client(s) and manage requests and expectations while providing exceptional client service.
• Perform other duties, as necessary, to meet corporate objectives.
• Performs audits and other consulting engagements.
• Travel as required

Requirements:

• Bachelor’s degree and a minimum of ten (10) years government, health care, pharmacy benefit management, compliance or quality profession (equivalent combination of education and experience considered.) Pharmacist preferred
• Must have strong Microsoft Office Suite skills. Advanced skills in Word, Excel, Access and PowerPoint required
• Experience with Medicare and/or Medicaid standards required
• Advanced degree or certification in audit, pharmacy or compliance discipline preferred
• Must have strong verbal and written communication skills.
• Individual should be detail oriented with strong organization, prioritization and analytical skills with the ability to work independently.
• Must work well under tight timelines and adapt quickly to change in a fast-paced, team-oriented, and high-growth environment.
• Consulting experience preferred.

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