Job description

Remote Position!

Responsible for pharmacy benefit services operations for the Medicare line of business. Operate as a Project Manager accountable for managing processes related to PBM Performance, Part D adjudication of benefits, and pharmacy audits. Function as a subject matter expert on Medicare Prescription Drug Coverage.

Essential Responsibilities:
Medicare Part D subject matter expert responsible for conveying applicable CMS regulatory guidance and expectations to staff within the pharmacy department. Consult with compliance divisions to provide strategic enterprise support. Maintain cross-functional relationships with Sales, Account Management, Government Programs, IS/IT, Internal Audit, and other applicable divisions to ensure compliant and accurate administration of pharmacy benefits across delivery systems.

Manage Part D benefit implementation and provide post-project oversight with the contracted PBM. Ensure pharmacy projects are completed while maintaining a strong focus on Medicare Part D compliance. Represent Pharmacy Health Plan in the role of a Medicare Subject Matter Expert by providing current operational state and conveying future needs. Update departmental policies as needed.

Facilitate cross-functional efforts throughout the enterprise to ensure optimal 5-star Medicare measures. Support annual readiness, maintain industry knowledge, and provide in-depth analysis to guarantee proper support for Medicare Programs. Manage pharmacy audits as they are received.

Work with leadership to manage the PBM relationship. Ensure Medicare Part D related contract terms are met. Address escalations with PBM staff to ensure favorable resolution. Work closely with business partners to facilitate prime client/vendor rapport while identifying cost saving opportunities for the enterprise.

Basic Qualifications: Experience
Minimum five (5) years of pharmacy operations (claims adjudication). Education
High School Diploma OR General Education Diploma (GED). License, Certification, Registration
N/A

Additional Requirements:
In depth knowledge of Medicare regulations.

Preferred Qualifications:
Five (5) years of experience in pharmacy health plan, PBM operations, participation in CMS audits.
Pharmacy Technician, Pharmacist by date of hire/transfer.
Bachelor's degree.
PrimaryLocation : Washington,Renton,Renton Administration - Adams
HoursPerWeek : 40
Shift : Day
Workdays : Mon, Tue, Wed, Thu, Fri
WorkingHoursStart : 08:00 AM
WorkingHoursEnd : 05:00 PM
Job Schedule : Full-time
Job Type : Standard
Employee Status : Regular
Employee Group/Union Affiliation : NUE-WA-04|NUE|Non Union Employee
Job Level : Manager with Direct Reports
Job Category : Pharmacy
Department : Renton Admin Adam - Rx Admin-Rx Benefit Management - 1130
Travel : No
Kaiser Permanente is an equal opportunity employer committed to a diverse and inclusive workforce. Applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), age, sexual orientation, national origin, marital status, parental status, ancestry, disability, gender identity, veteran status, genetic information, other distinguishing characteristics of diversity and inclusion, or any other protected status.

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