AnewHealth · 1 day ago
Manager, PBM Licensing & Regulations
Middlesex County, NJ
Full-time
Onsite
Mid, Senior Level
5+ years expAnewHealth is one of the nation’s leading pharmacy care management companies that specializes in caring for people with the most complex, chronic needs. The Manager, PBM Licensing & Regulations is responsible for regulatory oversight of Pharmastar, ensuring compliance with state and federal requirements while managing audits and providing guidance to the regulatory team.
Health CarePharmaceutical
Responsibilities
Oversee PBM Licensing – ensures Pharmastar is appropriately licensed based on services rendered
Track state and federal business requirements and manages compliance with associated regulatory reporting
Contact regulators for clarification and guidance as necessary
Manage regulatory audit proceedings
Coodinate pharmacy audits and distributes plan specific audit result letters
Participate in clients’ CMS financial audits providing documentation and reports as needed
Research regulatory issues as it relates to clients’ drug benefits and report results to clients
Develop Corrective Action Plans (CAPs) in response to audit findings
Monitor Medicare Part D regulation and guidance for applicability to Pharmastar. Assists with facilitating client awareness of regulatory changes
Responsible for maintaining P&P related to the regulatory compliance of Pharmastar includes drafting and editing
Provide guidance to the Pharmastar regulatory team, including training and development
Communicate with staff regarding needs of both the client and the company. Follow up to ensure appropriate action is taken in a timely fashion
Monitor client utilization and proactively solve issues as they arrive
Assure departmental compliance with company policies, procedures, standards and regulatory requirements
Promote staff enthusiasm and teamwork, support others in their job functions
Ensure that HIPAA guidelines are followed in every communication with clients
Stay current on plan and benefit structures, pharmacological updates, and Medicare Part D guidelines
Attend department and company meetings and educational programs upon request
Other related duties as assigned
Qualification
Required
Associate's degree or related experience
Minimum of 5 years of healthcare experience
Knowledge of Medicare Part D Plan and/or PACE Administration
Experience in PBM or pharmacy support role
Current on plan and benefit structures and Medicare guidelines
Drives a strong culture of owning problem solving and accountability
A forward-thinking personality capable of identifying areas for improvement
Outstanding written and verbal communication skills with clarity of thought and the ability to express, advocate and defend views effectively
Skilled in establishing and maintaining effective working relationships with clients, customers, and staff at all levels
Skilled in problem resolution; recommends suggestions to increase accuracy and/or efficiency
Ability to continuously display personal integrity and exemplary ethical standards
Tolerance for, and the ability to perform well, in stressful and ambiguous situations
Ability and flexibility to work in a relatively unstructured environment in a rapidly growing, dynamic company
Maintains safe working environment. Follow all Policies and Procedures and OSHA safety guidelines
Strong computer skills including using word processors, spreadsheets, and database software
Benefits
Medical/dental/vision
Flexible spending
Company-paid life insurance
Short-term disability
Voluntary benefits
401(k)
Paid Time Off
Paid holidays
Company
AnewHealth
AnewHealth is a pharmacy care that enhances healthcare outcomes by offering an assortment of solutions, comprising full pharmacy services.
1001-5000 employees
Funding
Current Stage
Late StageTotal Funding
unknownKey Investors
Vistria Group
2024-07-22Private Equity
Leadership Team
Brian Adams
President and CEO
Celynda Tadlock
President, Value-Based Care Solutions
Recent News
2025-12-02
Company data provided by crunchbase