Cynet Systems · 3 months ago
PBM Business Integration Specialist (Pharmacist)
Raleigh, NC
Full-time
Onsite
Mid, Senior LevelCynet Systems is seeking a PBM Business Integration Specialist who will serve as a subject matter expert for the Pharmacy Business Unit within the Medicaid Enterprise System Program. The role involves providing expertise in the development and implementation of the Medicaid Enterprise Modular PBM Solution and collaborating with stakeholders to ensure successful project execution.
EmploymentRecruitingStaffing Agency
Responsibilities
Serve as a subject matter expert for the Pharmacy Business Unit within the Medicaid Enterprise System (MES) Program
Provide expertise and business support in the development and implementation of the Medicaid Enterprise Modular PBM Solution
Assist with onboarding the PBM vendor, serving as a business stakeholder and representing the Pharmacy Business Unit throughout implementation
Lead and provide guidance on Clinical policies and Prior Authorizations, Drug Utilization Review (DUR) and pharmacy lock-in processes, Behavioral Health and A+ Kids programs, Preferred Drug List (PDL) and Medicaid Drug Rebate Program (MDRP), and Physician Administered Drug Program (PADP)
Collaborate with the Pharmacy Business team to define business process documents, business use cases, business case scenarios, and user acceptance test case scenarios
Actively support cross-functional activities to provide oversight of Medicaid programs
Communicate and collaborate with PBM business stakeholders, including Product Managers, Product Owners, and Business Leads
Research, recommend, and assist in implementing business initiatives and product enhancements
Provide input to senior-level decision-makers to develop long-range strategic alternatives for business solutions
Ensure compliance with all applicable policies and procedures
Support the product lifecycle from conception through implementation
Perform other duties as assigned to support the successful development and implementation of the PBM Solution in alignment with Medicaid program goals
Qualification
Required
In-depth knowledge of Medicaid Pharmacy Benefits Management processes and operational areas
Experience with Medicaid applications and preferably across pharmacy functional areas
Ability to translate business needs into detailed and actionable requirements
Strong collaboration and communication skills to engage with business and IT stakeholders
Experience supporting the full product lifecycle, from business requirements to functional specification and implementation
Preferred
Prior experience with Medicaid, managed care, and Pharmacy Benefit Manager (PBM) operations
Knowledge of behavioral health programs and pediatric initiatives (A+ Kids)
Experience with Medicaid Drug Rebate Program (MDRP) and Preferred Drug List (PDL) processes
Familiarity with physician-administered drug programs (PADP)
Company
Cynet Systems
Headquartered in Washington DC Metro Area, Cynet Systems is a top talent supplier for companies across North America.
Founded in 2010
1001-5000 employees
Funding
Current Stage
Late StageLeadership Team
Ashwani (Ash) M.
Partner and Co-CEO
Nikhil "Nick" Budhiraja
Founder / Co-CEO
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