To Apply for this Job Click Here
Responsibilities
- Oversee PBM Licensing – ensures Pharmastar is appropriately licensed based on services rendered.
- Track state and federal business requirements and manages compliance with associated regulatory reporting.
- Contact regulators for clarification and guidance as necessary.
- Manage regulatory audit proceedings.
- Coodinate pharmacy audits and distributes plan specific audit result letters.
- Participate in clients’ CMS financial audits providing documentation and reports as needed.
- Research regulatory issues as it relates to clients’ drug benefits and report results to clients.
- Develop Corrective Action Plans (CAPs) in response to audit findings.
- Monitor Medicare Part D regulation and guidance for applicability to Pharmastar. Assists with facilitating client awareness of regulatory changes.
- Responsible for maintaining P&P related to the regulatory compliance of Pharmastar includes drafting and editing.
- Provide guidance to the Pharmastar regulatory team, including training and development.
- Communicate with staff regarding needs of both the client and the company. Follow up to ensure appropriate action is taken in a timely fashion.
- Monitor client utilization and proactively solve issues as they arrive.
- Research regulatory issues as it relates to clients’ drug benefits and report results to clients.
- Assure departmental compliance with company policies, procedures, standards and regulatory requirements.
- Promote staff enthusiasm and teamwork, support others in their job functions.
- Ensure that HIPAA guidelines are followed in every communication with clients.
- Stay current on plan and benefit structures, pharmacological updates, and Medicare Part D guidelines.
- Attend department and company meetings and educational programs upon request.
Key Responsibilities simplified:
- Oversee PBM licensing across states
- Track and report on compliance with state/federal regulations
- Manage regulatory and pharmacy audits, including CMS audits
- Research and report on regulatory issues for client drug benefits
- Draft and maintain policies and procedures (P&Ps)
- Develop and implement Corrective Action Plans (CAPs)
- Support the team with training and regulatory updates
- Ensure compliance with HIPAA and company standards
- Monitor client activity and resolve issues proactively
Ideal Background:
- 5+ years in healthcare, pharmacy, or PBM setting
- Strong understanding of Medicare Part D, PACE programs, and pharmacy benefit structures
- Experience supporting regulatory or audit functions at a state level
- Associate’s degree required (or equivalent experience)
1421582-MW_1750385700