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Senior Consultant: Medicare Part D Pharmacy Benefits Management Executive

Job Summary:

Responsible for providing subject matter expertise and expert guidance on Medicare Part D and Pharmacy Benefits Managements Operations and strategy including plan design, claims processing, benefit strategies, formulary administration, Medication Therapy Management, bid process and strategy, and network management and credentialing.

Essential Functions:

Part D Functions

  • Subject matter expertise in Medicare Part D claims administration and all operational processes related to claims processing
  • Ability to review, interpret and implement state and federal guidance
  • Mentor and drive work product based on client needs
  • Oversee and administer ongoing monitoring program(s) based on guidance
  • Adhere to established corporate policies and procedures
  • Maintains awareness of current and future industry trends, including the regulatory environment, customer needs, opportunities and issues
  • Perform other duties, as necessary, to meet corporate objectives
  • Travel as required
  • .Manage technology utilized for existing products ensuring reviews are CMS compliant and complies with all security/privacy requirements.

Qualifications:

  • 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.)
  • Must have strong Microsoft Office Suite skills. Advanced skills in Word, Excel, Access and PowerPoint required
  • Extensive experience with Medicare Part D formulary administration, accurate claims adjudication and Prescription Drug Event (PDE) processing.
  • 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.
  • Must have an entrepreneurial spirit and demonstrate flexibility and open-mindedness to new ideas.

 


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Senior Consultant: Medicare Part D Pharmacy Benefits Management Executive

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