Description #LI-MM3
Responsibilities
- The Pharmacist Consultant works in a team environment on government client pharmacy benefit manager (PBM) audits and audit related consulting engagements to validate the integrity and accuracy of the administration of pharmacy benefit programs.
- This includes all aspects of contracted services including pricing adherence, formulary management, performance guarantees, rebate administration, and operational functions of the PBM.
Essential Functions and Primary Duties
- Perform pharmacy benefit related performance audits of government clients and health plans
- Participate in client meetings to obtain key benefit facts and documentation for the audits
- Collaborate in a team-based environment to perform the audits using a variety of analytical processes and claims data validation techniques
- Examine and validate initial analysis output
- Communicate and engage with the audited PBM to jointly review initial findings and assess any variances or discrepancies
- Prepare and review reports and workbooks of the audit outcome for clients
- Maintain security and confidentiality of all protected health information encountered during performance and other essential functions
- Participate in meetings, team projects, and discuss current topics with clients
- Collaborate with staff and listen and communicate effectively
- Additional responsibilities as assigned
Preferred Qualifications
- Pharmacy degree from ACPE – accredited pharmacy school
- Must have and preserve an active pharmacy license (any state)
- 6 + years of relevant work experience
- Minimum of 3 years of pharmacy managed care or prescription benefits management (PBM) experience required
- Well organized with a high degree of accuracy and attention to detail
- Strong analytical and problem solving skills, working knowledge of SQL a plus
- Demonstrated ability to communicate verbally and in writing with all levels of the organization, both internally and externally
- Effective in multi-tasking with planning and efficiency
- Proficient use of applicable software programs, including Microsoft Word, Excel, and PowerPoint
- Ability to function within a team environment as well as work independently
- Self-motivated with a strong work ethic
- Ability to travel overnight occasionally to client sites and regional offices
Qualifications
- Minimum Qualifications
- High school diploma or GED