Pharmacy Benefit Manager; PBM Market Regulation Consultant

Overview

Pharmacy Benefit Manager (PBM) Market Regulation Compliance Consultant — Position is work from home (USA). Risk & Regulatory Consulting, LLC.

• 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.

• 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.

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

Risk & Regulatory Consulting, LLC (RRC) is a national, leading professional services firm dedicated to providing exceptional regulatory services to clients. With over 100 experienced insurance professionals located in 22 states, we believe RRC is uniquely positioned to serve state insurance departments. We offer services in the following regulatory areas: financial examinations, market conduct examinations, insolvency and receiverships, actuarial services and valuations, investment analysis, reinsurance expertise, market analysis and compliance, and special projects.

We are a results oriented firm committed to success that builds long term relationships with our clients.

At RSM, we offer a competitive benefits and compensation package for all our people. We offer flexibility in your schedule, empowering you to balance life's demands, while also maintaining your ability to serve clients. Learn more about our total rewards.

All applicants will receive consideration for employment as RSM does not tolerate discrimination and/or harassment based on race; color; creed; sincerely held religious beliefs, practices or observances; sex (including pregnancy or disabilities related to nursing); gender; sexual orientation; HIV Status; national origin; ancestry; familial or marital status; age; physical or mental disability; citizenship; political affiliation; medical condition (including family and medical leave);

domestic violence victim status; past, current or prospective service in the US uniformed service; US Military/Veteran status; pre-disposing genetic characteristics or any other characteristic protected under applicable federal, state or local law.

Accommodation for applicants with disabilities is available…