Pharmacist Consultant

at RSM US LLP in ChicagoChicago, Illinois, United States

Job Description

We are the leading provider of professional services to the middle market globally, our purpose is to instill confidence in a world of change, empowering our clients and people to realize their full potential. Our exceptional people are the key to our unrivaled, inclusive culture and talent experience and our ability to be compelling to our clients. You'll find an environment that inspires and empowers you to thrive both personally and professionally. There's no one like you and that's why there's nowhere like RSM.

Pharmacist Consultant
Position is work from home
Risk & Regulatory Consulting, LLC

Specific Duties and Responsibilities:
Assess issuer/insurer compliance with market-wide requirements of ACA, MHPAEA, and state laws, including prescription drug formularies and design thereof and pharmacy claims benefits, including mandated benefits. Experience with PBMs a plus
Document in writing findings and reports of examinations, as needed
Prepare and present training on such topics
Participate in practice development activities with state and federal state agencies
Requirements:
Must have 15+ years of pharmacy experience as a registered pharmacist in the regulatory, insurance or healthcare industry or consulting industry, behavioral health, retail and/or clinical fields.
Must have 10+ years of Pharmacy Benefits Management (PBM) experience
PharmD is required
Strongly prefer candidates with state insurance or state health agency experience, CMS (Center for Medicare and Medicaid Services) and/or Office of Personnel Management experience
Must have experience with formulary reviews, pharmacy claims audits, auditing formularies and experience with formulary medication system
Experience running CMS formulary tools is a must along with review of formulary filings with state and federal agencies
Previous experience with formulary medication systems development to support process improvement strategies is helpful
Effectively use information technology (IT) to analyze data in areas of evidence based medicine practices, outcomes measurements, and process improvements
Must be able to interact with multi-disciplinary team of experts in areas of IT, health insurance, pharmacy, market regulation and healthcare policy
Must understand the fundamentals of pharmacy financial data and balancing clinical, regulatory, pharmaceutical industry and consumer access issues to formulary system development
Must be able to contribute decision support for system refinements pertinent to improving formulary review, optimizing review tools, and enhancing system performance.
Claims processing experience in retail or managed care
ACA and Mental Health Parity experience
Experience with managed care RX expenses
Proficient at using Microsoft Office (Word, Excel, Access, PowerPoint, and Outlook)
Effective written and oral communication skills
Must be able to meet tight deadlines and offer flexibility in hours
Regulatory experience is a plus
Strong writing skills
Strong analytical abilities and attention to detail
Experience and ability to work both independently and within a team environment - strong team player desired
Ability to adapt to changing priorities, self-motivated and energetic qualities desirable
Managed Care/Pharmacy Benefit Management and pharmacy audit experience preferred
A combination of pharmaco-economic, drug information, clinical experience is highly desirable
Must be comfortable doing presentations and conducting phone calls with multiple team members
Travel as needed

At RSM, we offer a competitive benefits and compensation package for all our people. We support and inspire you to prioritize your wellbeing by delivering personalized, holistic programming for your physical, emotional, financial and community wellbeing. RSM has a generous time off policy with at least 14 paid holidays, wellbeing days and associate and above access to self-managed time off. We offer flexibility in your schedule, empowering you to balance life's demands, while also maintaining your ability to serve clients. Learn more about our total rewards at .

RSM is proud to be an Affirmative Action and Equal Employment Opportunity employer. We are proud to provide our employees with tools to assist them in being successful in achieving both personal and professional goals. We welcome and support all our employees to thrive in an environment free of discrimination and harassment. As an Affirmative Action and Equal Opportunity Employer all applicants will receive consideration for employment as RSM does not tolerate discrimination and/or harassment based on race; color; creed; sincerely held religious beliefs, practices or observances; sex (including pregnancy or disabilities related to nursing); gender (including gender identity and/or gender expression); sexual orientation;... For full info follow application link.

RSM is an equal opportunity/affirmative action employer. Minorities/Females/Disabled/Veterans.