Pharmacy Benefits Expert

11 hours ago

Brisbane, Queensland, Australia beBeeRegulation Full time $93,400 - $161,000
Job Opportunity

The Pharmacy Benefits Specialist II position is a critical role responsible for overseeing Pharmacy Benefits Manager (PBM) activities and serving as an expert in pharmacy benefits and drug medical benefits.

Key Responsibilities:
  • Monitor PBM activities, including daily monitoring of coverage determinations, denied claims, hospice, and end-stage renal disease (ESRD) claims.
  • Serve as an expert in pharmacy benefits and drug medical benefits, providing research, data, and member communications and resolution regarding all Part D grievances, including vendor oversight of such activities.
  • Attend and participate in meetings with internal and external customers as it relates to pharmacy and coordinates support activities related to the Pharmacy and Therapeutics (P&T) Committee and formulary maintenance as required.
  • Implement Medicare, Ohio Department of Insurance (ODI), and NCQA pharmacy regulatory changes.
Requirements:
  • Bachelor's degree or equivalent college credits.
  • Registered Pharmacy Technician License.
  • Certified Pharmacy Technician (CPhT) preferred.
  • Three years performing same or similar responsibilities, with relevant experience in health plan operations, pharmacy, or PBM positions.
Skills and Qualifications:
  • Demonstrate expertise in Medicare Part D, ODI, and NCQA regulations.
  • Effectively utilize MS Word, Excel, and other software applications to perform job duties.
  • Make sound decisions and recommendations based on consideration of facts, priorities, resources, and alternatives.
  • Ability to adjust work hours to meet business demands.
  • Required to provide oversight of time-sensitive member/provider requests, including participation in a weekend on-call rotation.
  • Organize and manage time to accurately complete tasks within designated time frames in a fast-paced environment.
  • Ability to effectively interact with populations of patients/customers with an understanding of their needs for self-respect and dignity.

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