PBM Licensing - Plano, United States - Maxor

Description

Overview:

The PBM Licensing & Compliance Manager performs a wide variety of specialized operational functions for the Legal and Compliance department including pharmacy benefit management licensure, reporting, Medicaid provider enrollment, business registration, research, regulatory support, administrative support, and projects as assigned.

Location

Remote, home-based within the Continental US.

Our Company

Maxor is a leading pharmacy care solutions company dedicated to improving patient outcomes and lowering the total cost of care through our clinically integrated set of pharmacy care solutions. Our teams help optimize the pharmacy experience for patients, our customers, their employees, and members whether its through our customized pharmacy benefit offerings; providing access to prescription medications and therapies through our home delivery and specialty pharmacies; or delivering clinical and financial value with our end-to-end pharmacy management solutions. With a legacy of exceptional service and deep clinical and pharmacy expertise, Maxor has been a trusted partner enabling pharmacy care since 1926.

Why Maxor?

Pharmacies are essential to healthcare, with nearly 90% of the US population living within 5 miles of one and seeing their pharmacist an average of 12 times a year. Providing a positive patient experience is crucial to ensuring patients adhere to their therapies. At Maxor, we recognize that our employees are our most valuable assets. We actively seek and retain talented professionals who are mission-driven to improve healthcare outcomes for patients. And, our employees are essential to their own well-being, finding fulfillment in meaningful work, teamwork & collaboration, competitive compensation, work-life balance, diverse and inclusive teams, and limitless career possibilities. With a workforce of 1,100+ and almost a century of pharmacy experience, we offer the stability of a Fortune 500 company and the energy and innovation of a startup. Our expertise and technology support the entire pharmacy ecosystem, but our impact goes beyond pharmacy services. We enable pharmacy care.

LICENSING:

• Supervises and trains Licensing Associates and Licensing Specialists
• Actively participates in cross-functional planning meetings
• Creates and implements the plan for licensing projects
• Serves as primary support and subject matter expert for all licensure functions and processes
• Develops and maintains meaningful relationships with internal stakeholders state and federal regulators
• Meets all licensure and reporting deadlines
• Leads PBM reporting to regulatory agencies

MEDICAID AND MEDICARE ENROLLMENT

• Serves as primary support and subject matter expert for provider enrollment applications in Medicaid and Medicare
• Actively participates in cross-functional pharmacy implementation meetings

BUSINESS REGISTRATION:

• Serves as primary support for all business registration processes
• Provides assistance to primary support in order to meet business registration deadlines

RESEARCH:

• Serves as primary support for licensing-related research requests
• Serves as secondary support for research on new laws and regulations impacting the PBM

PROJECTS & ADMINISTRATION:

• Executes or provides assistance with projects as assigned
• Maintain and update databases and tracking systems
• Create and design general correspondences, memos, business information etc. Proofread copy for spelling, grammar, and layout, making appropriate changes. Responsible for accuracy and clarity of final copy.
• Create, compose, and edit technical and/or administrative correspondence and documentation; screen and evaluate incoming and outgoing correspondence and prepare responses as appropriate
• Prepare internal reports such as check requests, expense reports, IT requests, etc.
• Enhance professional growth and development through participation in educational programs, current literature, in-service meetings, and workshops.
• Maintain good inter/intra departmental relationships. Work to create an amiable atmosphere within the department and company.
• Respond to change, performance improvement support, professional growth opportunities, and meet development goals.

Education:

• High school diploma or equivalent. College degree preferred.

Experience:

Required:

• 4+ years of pharmacy benefit management (PBM) licensing or equivalent experience
• 2+ years of experience in handling provider applications for enrollment in Medicaid or Medicare
• 1+ year of experience in completing and maintaining business registrations
• Intermediate knowledge of Microsoft Office and Adobe products

Preferred:

• Roles within legal (paralegal), regulatory, audit, and/or compliance departments
• Advanced technical level skillset with Microsoft Office and Adobe Acrobat products

Knowledge, Skills, and Abilities:

1. Possess a strong attention to detail and consistently adhere to administrative procedures and regulatory timelines
2. Able to review and research state and federal regulations and determine how regulations apply from licensing and reporting perspective
3. Must have strong written and verbal communication skills
4. Effectively develop meaningful relationships with a wide range of individuals at all levels of an organization, both internal and external
5. Thoughtfully addresses requests for information and raise items to management as warranted
6. Must have a strong working knowledge of Microsoft Office (specifically, Word, Outlook, and Excel) and Adobe Acrobat
7. Continually seek ways to improve processes and propose changes effectively
8. Create, compose, and edit written materials, effectively execute tasks, and organize efficiently
9. Document matters as warranted and communicate and/or store information as needed
10. Possess knowledge and experience to make administrative and minor procedural decisions and judgments on sensitive, confidential issues with little to no direction
11. Gather data from internal sources, compile information, and prepare reports
12. Prioritize, organize and coordinate daily work timely; effectively work under pressure, and manage to competing deadlines with some direction
13. Develop and maintain record keeping systems and procedures
14. Maintain the highest level of confidentiality of company, personal, and sensitive information
15. Knowledge of clerical, office administrative procedures, and knowledge of use and operation of standard office equipment

WE OFFER

At Maxor, we foster a diverse and progressive culture that promotes a work-from-home model and a "dress-for-your-day" approach to work attire. Our team-oriented environment encourages collaboration and innovation.

We offer highly competitive compensation and comprehensive health benefits including:

• Comprehensive mental health and wellbeing resources
• Nationwide Blue Cross Blue Shield PPO with employee-friendly plan design, including a $850 individual annual medical deductible and $25 office visit copays, with low biweekly premiums
• Company-paid basic life/AD&D, short-term and long-term disability insurance
• Rx, dental, vision, other voluntary benefits, and FSA
• Employer-matched 401k Plan
• Industry-leading PTO plan
• And more

Apply today at

Maxor is an EOE, including disability/vets