Pharmacist Consultant (Pharmacy Benefit Management Subject Matter Expert)

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The Pharmacist Consultant works in a team environment on government client pharmacy benefit manager (PBM) audits and audit related consulting engagements to validate the integrity and accuracy of the administration of pharmacy benefit programs. This includes all aspects of contracted services including pricing adherence, formulary management, performance guarantees, rebate administration, and operational functions of the PBM.

Essential Functions and Primary Duties

• Perform pharmacy benefit related performance audits of government clients and health plans
• Participate in client meetings to obtain key benefit facts and documentation for the audits
• Collaborate in a team-based environment to perform the audits using a variety of analytical processes and claims data validation techniques
• Examine and validate initial analysis output
• Communicate and engage with the audited PBM to jointly review initial findings and assess any variances or discrepancies
• Prepare and review reports and workbooks of the audit outcome for clients
• Maintain security and confidentiality of all protected health information encountered during performance and other essential functions
• Participate in meetings, team projects, and discuss current topics with clients
• Collaborate with staff and listen and communicate effectively
• Additional responsibilities as assigned

Preferred Qualifications

• Pharmacy degree from ACPE – accredited pharmacy school
• Must have and preserve an active pharmacy license (any state)
• 6 + years of relevant work experience
• Minimum of 3 years of pharmacy managed care or prescription benefits management (PBM) experience required
• Well organized with a high degree of accuracy and attention to detail
• Strong analytical and problem solving skills, working knowledge of SQL a plus
• Demonstrated ability to communicate verbally and in writing with all levels of the organization, both internally and externally
• Effective in multi-tasking with planning and efficiency
• Proficient use of applicable software programs, including Microsoft Word, Excel, and PowerPoint
• Ability to function within a team environment as well as work independently
• Self-motivated with a strong work ethic
• Ability to travel overnight occasionally to client sites and regional offices

Minimum Qualifications

• High school diploma or GED