Pharmacy Benefit Management (PBM) Administration and Oversight Director
Columbia, SC 
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Posted 1 day ago
Job Description
Summary Negotiates Pharmacy Benefit Management (PBM) contract terms with Commercial Business self-funded groups for retail/mail order/specialty pharmacy service and specialty drug medical management rebate sharing services. Monitors contract performance including performance guarantees, financial guarantees, and compliance with state and federal regulatory requirements specific to self-funded groups. Negotiates, and oversees Non-Disclosure Agreements associated with third party request for release of pharmacy data containing confidential information, (ii) requests from third parties to audit contract terms (iii) requests from self-funded customer to conduct market check evaluations. Provides formal contract management and oversight for the Corporate PBM agreements.Description 

30% Represent the company through the life cycle of the pharmacy benefit management services extended to self-funded clients. This includes responding to contractual terms in RFPs, contract drafting including state and federal regulatory requirements, contract negotiations, contract interpretation, contract performance measurement against guaranteed terms, initiating renewal offers and amendments, responding to and resolving client disputes and coordinating activities associated with termination of contract.

20% Develop, implement and oversee a formal Corporate PBM contract management oversight program to measure ongoing compliance with Corporate PBM guarantees.

15% Negotiate and oversee Non-Disclosure Agreements associated with third party request for release of pharmacy data containing confidential information, reviews and facilitates requests from self-funded clients to audit contact terms; oversees market check rights and results in accordance with contract terms; and other self-funded client pharmacy related contracting initiatives

15% Advise business leaders on client and contract related matters, including potential liability and exposure, and resolving disputes.

10% Collaborate with enterprise counsel and Government Affairs staff on various matters relating to clients and the PBM business in general.

10% Operates in a strategic and pro-active manner to assist internal business clients in managing their relationships with clients, and managing the regulatory risk related to the provision of prescription drug benefits to client services.

Required Education:

  • Bachelor's Degree

Preferred Education:

  • Master's Degree

Required Work Experience:

  • Eight plusyears of experience in contract managementOR detailed pharmacy oversight work experience.

  • Four plusyears of previous management experienceORfour plusyears of equivalent military experience in grade E4OR above (may be concurrent with theeight plusyears).

Preferred Work Experience:

  • Prior software data analytics experience in MS Access, Excel and SQL.

  • In depth experience in contract interpretation and application of contractual terms and obligations.

  • Ten plusyears of experience in contract managementOR detailed PBM oversight work experience.

  • Sixplusyears of previous management experienceORsix years of equivalent military experience in grade E4OR above (may be concurrent with theten plusyears).

Required Skills and Abilities:

  • Excellent analytical, critical-thinking, and problem-solving skills.

  • Ability to work in a highly changing environment.

  • Ability to persuade, negotiate, or influence.

  • Excellent presentation skills with strong attention to detail.

  • Demonstrated legal knowledge, leadership and sound strategic thinking skills.

  • Ability to effectively communicate verbally and in writing to all levels throughout the company and client base.

Work Environment:

  • Typical office environment.

  • May require travel.



 

We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer.

Equal Employment Opportunity Statement

BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains Affirmative Action programs to promote employment opportunities for minorities, females, disabled individuals and veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations.

We are committed to working with and providing reasonable accommodations to individuals with physical and mental disabilities.

If you need special assistance or an accommodation while seeking employment, please e-mail abilities@bcbssc.com or call 1-800-288-2227, ext. 43172 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis. 

 

Job Summary
Start Date
As soon as possible
Employment Term and Type
Regular, Full Time
Required Experience
8+ years
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