Pharmacy Benefits Management

KMM an ISO 9001:2015, CMMI Level 2 certified company provides high-quality IT consulting services and innovative solutions by using the most effective and modern technologies. We have a core group of Subject Matter Experts with certifications and immense experience in successfully delivering mission-critical solutions. We have extensive industry experience in the financial, insurance, Health IT, media, marketing, retail, and government markets. We have a proven track record in understanding client s business challenges, determine a customer-focused solution, and provide the technical implementation and documentation to bring it to fruition.

Position: Pharmacy Benefits Management
Location: Baltimore, MD #HYBRID
Duration: Contract to hire

Job Description:

• Pharmacy Benefits Management Strategy and Implementation Consultant
• This role requires deep expertise in pharmacy supply chain financial management, PBM transitions, and pharmacy operations.
• The successful candidate will be responsible for a new pharmacy supply chain implementation and PBM transition, including managing execution activities, aligning stakeholders, contract management, vendor relationship management, and driving business readiness.
• Required Previous exp. with Implementations in Pharmacy benefits manager.
• Work with Project Manager, IT business managers and Incoming and External stake holders.
• Project Deliverables and Financial Components.
• Should have strong Project Implementation.

Project Leadership & Accountability:

• Manage business execution team, ensuring alignment of team efforts with goals, objectives, and timelines.
• Collaborate with the business sponsor, IT lead, PMO, and vendor partners to provide leadership and strategic direction, ensuring timely and successful delivery of business-related milestones.
• Make key business decisions in partnership with the business sponsor.

Contracts & Vendor Management:

• Negotiate and manage PBM and supply chain contracts and Statements of Work (SOWs) with vendors, ensuring that contractual obligations are met and deliverables are aligned with business needs.
• Manage vendor performance, working with the PMO, IT, and Operations teams to address any issues or risks that arise during implementation.

Value Story Development and Communication:

• Develop and validate the value story for the PBM supply chain model, including calculating and quantifying the financial and investment value to the organization.
• Work closely with the business sponsor to ensure the value story reflects the broader organizational impact, including cost savings, efficiency improvements, and enhanced service delivery.
• Regularly update stakeholders on the realized value, change in value and adjusting strategies where necessary.

Cross-functional Collaboration: and Business Readiness:

• Collaborate with the IT Lead, PMO, Operations, vendor partners, and other departments to ensure seamless integration of business processes with the PBM supply chain model.
• Act as the liaison between business stakeholders and project teams, translating business requirements into actionable tasks and ensuring alignment across all parties.
• Facilitate business-focused meetings to discuss project status, issues, risks, and decisions with key stakeholders.
• Work closely with the PMO office, IT, Operations, and vendors to prepare for net new roles and functions and support business readiness efforts, including ensuring effective communication, training, and documentation to prepare impacted teams for the transition.

Risk Management & Performance Optimization:

• Identify opportunities for operational improvements and provide recommendations to optimize business processes, enhance service delivery, and drive cost savings and efficiencies
• Proactively identify and manage business related risks and issues, escalating as necessary to ensure timely resolution and minimize disruptions.
• Work collaboratively with cross-functional teams and vendor partner, to develop and implement mitigation plans and corrective actions as needed.

Qualifications:

• Bachelor's Degree (Business Administration, Healthcare Management, Supply Chain Management, or related field.)
• Required Experience: Previous experience leading a PBM health plan transition, 7 years' experience in total in either pharmacy supply chain, pharmacy business operations, PBM operations, PBM contracting, pharmacy services, and supply chain management.
• Strong knowledge of PBM contracting, claims adjudication, pharmacy network management, formulary design, financial processes including rebates and discounts, and compliance regulations.
• Strong decision-maker with the ability to navigate complex business issues and make strategic choices in collaboration with the business sponsor.
• Expertise in Medicare, Medicaid, and Commercial pharmacy operations.
• Experience managing PBM implementations or transitions at a health plan, PBM, or consulting firm.
• Adaptability and resilience in a dynamic, fast-paced environment.
• Excellent interpersonal skills with the ability to influence and engage senior stakeholders and vendors.
• Highly organized and detail-oriented, with the ability to manage large-scale, multi-functional, multi-organizational projects with executive visibility.
• Ability to communicate at all organizational levels from individual contributor level to executive leaders. Excellent communication, negotiation, stakeholder engagement, and relationship management skills, both verbal and written.

Mandatory Skills:

• Strong knowledge of PBM contracting, claims adjudication, pharmacy network management, formulary design, financial processes including rebates and discounts, and compliance regulations.
• Strong decision-maker with the ability to navigate complex business issues and make strategic choices in collaboration with the business sponsor.
• Expertise in Medicare, Medicaid, and Commercial pharmacy operations.
• Experience managing PBM implementations or transitions at a health plan, PBM, or consulting firm.

Thanks & Regards,
--
LAXMAN
KMM Technologies, Inc.
CMMI Level 2 | ISO 9001 | ISO 20000 | ISO 27000 Certified
Tel: |Email:

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