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Form of workJob Description
SUMMARY OF OVERALL PURPOSE
Sr. Pharmacy Strategies Specialist will assist Executive Director regarding the management of the contracted pharmacy benefit managers (PBM's) and their related programs. Will have a key role in recommending and implementing changes to the pharmacy programs, handling escalated issues relating to pharmacy benefits, and supporting day to day interfaces.
Duties include assistance with contract maintenance, product enhancements, regulatory compliance and oversight of the various components and program features comprising pharmacy offerings. Maintain accuracy of the program/contract intent and analyze program's continued effectiveness.
Support and assist the Executive Director in negotiation with PBMs, as well as new relationships and business opportunities to enhance the value that Trustmark brings to its members. You will also work closely with all contracted Pharmacy Benefit Managers to assure that new and existing legislations/regulations are implemented or updated.
KEY ACCOUNTABILITIES
• Handle all day-to-day operational interfaces with Trustmark and the contracted PBM as necessitated by each functional area (Sales, Customer Service, Product, Case Management, Compliance/Law, IT, etc.).
• Resolve pharmacy operational issues (eligibility, plan set-up, benefits/coverage) in a timely manner.
• Effectively communicate issues and expected outcomes to all involved parties
• Investigate any pharmacy claim issues that may arise, including working to obtain exception approval or provide denial explanation.
. Analyze claim trends with oversight of process improvement.
• Contribute to product development for pharmacy programs that will result in a more cost-effective product, administrative efficiencies, or an enhancement of current benefits. Duties may include researching new solutions or vendors, analysis of related data/analytics, recommendations, and project proposal development.
. Oversee assigned projects or implementations to assure project completion in accordance with project management guidelines. Follow-up as required to maintain the clinical/financial benefits of the original project goals.
• Work with compliance analyst to understand/interpret legislative changes to determine applicability to PBMs, pharmacy benefits, or pharmacy related programs.
• Partner with PBM and functional areas to implement required changes.
. Act as subject matter expert with compliance, legal and IT related to PBM and Pharmacy benefits. Ensure all plans are compliant with new legislation relating to pharmacy benefits or programs. Implement any necessary changes using compliance tracking system.
• Collaborate with Executive Director and Pharmacy Consultant to recommend and facilitate needed changes to contract terms
• Work with PBM to ensure performance guarantees and other contractual obligations are met.
. Participate in weekly and quarterly meetings to assure issues are resolved and/or strategies are being developed for the success of the relationship.
• Create training documents and other communications related to pharmacy benefit revisions and other changes in a process or procedure.
• Facilitate all formulary changes required by the PBM. This includes documentation of changes, member communications and updating of Key Client custom documents.
• Support of any needed customer communications when appropriate.
. Assist and/or draft language changes for plan documents or administrative services agreements that reflect compliance with legislation and effectively communicate all PBM changes to management and applicable areas.
. Other duties as needed/assigned.
EDUCATION and EXPERIENCE
Minimum Requirements
• Minimum 3 years of pharmacy, managed care, or comparable healthcare management experience.
. Must have superior written, verbal, collaboration, and interpersonal communication skills with the ability to explain complex processes and procedures and quickly establish credibility.
• Ability to work independently, problem solve, and make decisions with limited supervision. Must be able to manage several projects and programs concurrently.
• Strong technical skills and attention to detail required.
• Proven program development and project management experience. Demonstrated ability to plan, prioritize, coordinate, and manage projects in a deadline-sensitive environment. Ability to participate and work with a multi-functional project team.
• Must be able to handle confidential information.
. Requires a Customer Services skill set and mindset.
Preferred
• . College degree preferred but experience will be considered.
. PBM contracting experience preferred.
. An understanding and working knowledge of vendor contracting, health insurance or self-insurance contracting including full knowledge of insurance operations preferred.
SUMMARY OF OVERALL PURPOSE
Sr. Pharmacy Strategies Specialist will assist Executive Director regarding the management of the contracted pharmacy benefit managers (PBM's) and their related programs. Will have a key role in recommending and implementing changes to the pharmacy programs, handling escalated issues relating to pharmacy benefits, and supporting day to day interfaces.
Duties include assistance with contract maintenance, product enhancements, regulatory compliance and oversight of the various components and program features comprising pharmacy offerings. Maintain accuracy of the program/contract intent and analyze program's continued effectiveness.
Support and assist the Executive Director in negotiation with PBMs, as well as new relationships and business opportunities to enhance the value that Trustmark brings to its members. You will also work closely with all contracted Pharmacy Benefit Managers to assure that new and existing legislations/regulations are implemented or updated.
KEY ACCOUNTABILITIES
• Handle all day-to-day operational interfaces with Trustmark and the contracted PBM as necessitated by each functional area (Sales, Customer Service, Product, Case Management, Compliance/Law, IT, etc.).
• Resolve pharmacy operational issues (eligibility, plan set-up, benefits/coverage) in a timely manner.
• Effectively communicate issues and expected outcomes to all involved parties
• Investigate any pharmacy claim issues that may arise, including working to obtain exception approval or provide denial explanation.
. Analyze claim trends with oversight of process improvement.
• Contribute to product development for pharmacy programs that will result in a more cost-effective product, administrative efficiencies, or an enhancement of current benefits. Duties may include researching new solutions or vendors, analysis of related data/analytics, recommendations, and project proposal development.
. Oversee assigned projects or implementations to assure project completion in accordance with project management guidelines. Follow-up as required to maintain the clinical/financial benefits of the original project goals.
• Work with compliance analyst to understand/interpret legislative changes to determine applicability to PBMs, pharmacy benefits, or pharmacy related programs.
• Partner with PBM and functional areas to implement required changes.
. Act as subject matter expert with compliance, legal and IT related to PBM and Pharmacy benefits. Ensure all plans are compliant with new legislation relating to pharmacy benefits or programs. Implement any necessary changes using compliance tracking system.
• Collaborate with Executive Director and Pharmacy Consultant to recommend and facilitate needed changes to contract terms
• Work with PBM to ensure performance guarantees and other contractual obligations are met.
. Participate in weekly and quarterly meetings to assure issues are resolved and/or strategies are being developed for the success of the relationship.
• Create training documents and other communications related to pharmacy benefit revisions and other changes in a process or procedure.
• Facilitate all formulary changes required by the PBM. This includes documentation of changes, member communications and updating of Key Client custom documents.
• Support of any needed customer communications when appropriate.
. Assist and/or draft language changes for plan documents or administrative services agreements that reflect compliance with legislation and effectively communicate all PBM changes to management and applicable areas.
. Other duties as needed/assigned.
EDUCATION and EXPERIENCE
Minimum Requirements
• Minimum 3 years of pharmacy, managed care, or comparable healthcare management experience.
. Must have superior written, verbal, collaboration, and interpersonal communication skills with the ability to explain complex processes and procedures and quickly establish credibility.
• Ability to work independently, problem solve, and make decisions with limited supervision. Must be able to manage several projects and programs concurrently.
• Strong technical skills and attention to detail required.
• Proven program development and project management experience. Demonstrated ability to plan, prioritize, coordinate, and manage projects in a deadline-sensitive environment. Ability to participate and work with a multi-functional project team.
• Must be able to handle confidential information.
. Requires a Customer Services skill set and mindset.
Preferred
• . College degree preferred but experience will be considered.
. PBM contracting experience preferred.
. An understanding and working knowledge of vendor contracting, health insurance or self-insurance contracting including full knowledge of insurance operations preferred.
