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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.Key Responsibilities simplified:Oversee PBM licensing across statesTrack and report on compliance with state/federal regulationsManage regulatory and pharmacy audits, including CMS auditsResearch and report on regulatory issues for client drug benefitsDraft and maintain policies and procedures (P&Ps)Develop and implement Corrective Action Plans (CAPs)Support the team with training and regulatory updatesEnsure compliance with HIPAA and company standardsMonitor client activity and resolve issues proactivelyIdeal Background:5+ years in healthcare, pharmacy, or PBM settingStrong understanding of Medicare Part D, PACE programs, and pharmacy benefit structuresExperience supporting regulatory or audit functions at a state levelAssociate's degree required (or equivalent experience) 1421582-MW_1750385700 To Apply for this Job Click Here