Easter Seals Jobs

Duties & Responsibilities:

• Monitors all State & Federal regulations and program changes impacting pharmacy benefits and ensures timely implementation and/or compliance with regulations to meet or exceed audit standards.

• Responsible for new programs and initiatives assigned to meet organization operations, regulatory, compliance and strategic goals. (e.g.M3P)

• Responsible for preparing, reviewing, analyzing and reporting initiative metrics in order to gauge program success/failures and opportunities for improvement

• Performs operational oversight of M3P vendor and PBM (Pharmacy Benefit Manager) data and activities.

• Develops strategies to optimize pharmacy benefits, pharmacy operations and member experience across all lines of business.

• Assists in regulatory and compliance audits for all plans

• Additional duties as necessary

Minimum Qualifications:

• Bachelors degree from an accredited institution

• Knowledge of regulations of the Centers for Medicare and Medicaid Services and the New York State Department of Health

• Demonstrated critical thinking and problem-solving skills.

• Ability to lead large and small working meetings.

• Outstanding communicator with excellent verbal, written and presentation skills.

• PC Skills with Microsoft Word, PowerPoint (creating presentations and slides), Excel (Pivot tables), Access (creating databases), Visio (creating workflow charts)and Adobe Acrobat.

Preferred Qualifications:

• Knowledge of billing practices in the medical and pharmacy benefits.

• Experience with pharmacy benefit management oversight including maintaining policies and procedures related to benefits administration, claims adjudication and utilization management processes.

• Demonstrate effective communication and presentation skills in small and large groups

• Demonstrate ability to initiate, prioritize, organize and manage multiple priorities with acute attention to detail

Compliance & Regulatory Responsibilities: Noted above

License/Certification: N/A

WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to mental or physical disability, race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.