Enterprise Architect
Random Bit LLC
Cloud
Market Regulation Consultant – Pharmacy Benefit Manager
RSM US LLP
full-time
Posted on:
Location Type: Remote
Location: Remote • 🇺🇸 United States
Visit company websiteSalary
💰 $69,800 - $132,000 per year
Job Level
Mid-LevelSenior
About the role
- Assess PBM compliance with state and federal laws
- Understand PBM operations in relation to the pharmaceutical supply chain
- 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 findings and reports of examinations in writing, as needed
- Prepare and present training on such topics
- Participate in practice development activities with state and federal state agencies
Requirements
- Must have 5+ years of PBM operational and/or compliance/internal audit experience
- Prior consulting experience in healthcare, managed care, or PBM industries
- Working knowledge of Pharmacy Benefit Managed Care business or PBM experience
- Bachelor’s Degree in Business, Risk Management, Accounting, Finance or applicable fields
- 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
- 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
- RSM does not intend to hire entry level candidates who will require sponsorship now OR in the future
Benefits
- Competitive benefits and compensation package
- Flexibility in your schedule, empowering you to balance life’s demands, while also maintaining your ability to serve clients
- Individuals selected for this role will be eligible for a discretionary bonus based on firm and individual performance
- Accommodation for applicants with disabilities is available upon request in connection with the recruitment process and/or employment/partnership
- Learn more about our total rewards at https://rsmus.com/careers/working-at-rsm/benefits
- Join our Talent Community
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
PBM compliancepharmaceutical supply chainMAC pricingNADAC reimbursementsspread pricingpharmacy claimsdata analysisreimbursement methodologypharmacy auditnetwork adequacy reviews
Soft skills
effective communicationanalytical abilitiesattention to detailproblem solvingcollaborationadaptabilitypresentation skillsself-directedtime managementclient interaction
Certifications
IRES DesignationCertified Insurance ExaminerAccredited Insurance ExaminerMarket Conduct Managementcertified PBM designation
