at Beacon Hill Solutions Group, LLC in Chicago, Illinois, United States
Job Description
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.
- 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
- 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)
California residents: Qualified applications with arrest or conviction records will be considered for employment in accordance with the Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act.
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Company Profile:
Founded by industry leaders to set a new standard in search, career placement and flexible staffing, we deliver coordinated staffing solutions with unparalleled service, a commitment to project completion and success and a passion for innovation, creativity and continuous improvement.
Our niche brands offer a complete suite of staffing services to emerging growth companies and the Fortune 500 across market sectors, career specialties/disciplines and industries. Over time, office locations, specialty practice areas and service offerings will be added to address ever changing constituent needs.
Learn more about Beacon Hill and our specialty divisions, Beacon Hill Associates, Beacon Hill Financial, Beacon Hill HR, Beacon Hill Legal, Beacon Hill Life Sciences and Beacon Hill Technologies by visiting www.bhsg.com .
Benefits Information:
Beacon Hill offers a robust benefit package including, but not limited to, medical, dental, vision, and federal and state leave programs as required by applicable agency regulations to those that meet eligibility. Upon successfully being hired, details will be provided related to our benefit offerings.
We look forward to working with you!
Beacon Hill. Employing the Future™
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