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RSM US LLP · 2 weeks ago

Pharmacy Benefit Manager (PBM) Market Regulation Consultant

United States

Full-time

Onsite

Senior Level

$85K/yr - $162K/yr

5+ years exp

RSM US LLP is a leading provider of professional services to the middle market globally, focused on empowering clients and their people. The Pharmacy Benefit Manager (PBM) Market Regulation Consultant will assess compliance with laws, evaluate contracts, and conduct various reviews to ensure PBM operations align with regulations.

AccountingConsultingFinancial Services

Growth Opportunities

No H1B

Responsibilities

Assess PBM compliance with state and federal laws. Understanding of the PBM operations in relation to the pharmaceutical supply chain is essential

Evaluate PBM contracts with health plans and pharmacies to determine if they contain discriminatory or non-compliant provisions

Perform comparative reviews of MAC pricing lists/contracts

Conduct reimbursement methodology reviews, pharmacy audit reviews and network adequacy reviews

Validate and analyze the quarterly and annual data reports

Monitor PBM marketplace activities and trends

Document in writing findings and reports of examinations, as needed

Prepare and present training on such topics

Participate in practice development activities with state and federal state agencies

Qualification

PBM operational experienceCompliance/internal audit experiencePharmaceutical supply chain knowledgeMicrosoft Office proficiencyRegulatory experienceAnalytical abilitiesTeam orientationEffective communication skillsProblem-solving skillsPresentation skillsAdaptability

Required

Must have 5+ years of PBM operational and/or compliance/internal audit experience and prior consulting experience in healthcare, managed care, or PBM industries and working knowledge of Pharmacy Benefit Managed Care business or PBM experience

Bachelor's Degree in Business, Risk Management, Accounting, Finance or applicable fields

Ability to interact effectively across department lines and with all levels of management

Must understand the fundamentals of the pharmaceutical supply chain, Maximum Allowable Cost (MAC) pricing, national average drug acquisition cost (NADAC) reimbursements, spread pricing, and pharmacy claims and balancing clinical, regulatory, pharmaceutical industry issues

Proficient at using Microsoft Office (Word, Excel, Access, PowerPoint, and Outlook)

Effective written and oral communication skills

Regulatory experience is a plus

Strong analytical abilities and attention to detail

Self-directed and the ability to problem solve in a positive, productive manner

Strong communication skills, collaborative, adaptable to changing priorities and ability to execute on tight deadlines Strong team orientation and the ability to work with a variety of people

Must be comfortable doing presentations and conducting phone calls with multiple clients and team members

Travel as needed, minimal

Preferred

IRES Designation such as Certified Insurance Examiner, Accredited Insurance Examiner or Market Conduct Management or a certified PBM designation

Benefits

Flexibility in your schedule

Discretionary bonus based on firm and individual performance

Company

RSM US LLP

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Founded in 1926

Chicago, Illinois, USA

10001+ employees