MES PBM Product Integration Specialist

Job Number: 800230438
Job Type: Full Time(FTE)

Candidate Type – USA Work Authorization

Job Location – Raleigh, NC

Job Description

We are seeking a highly skilled Pharmacy Benefits Management (PBM) Product Integration Specialist to join the Medicaid Enterprise System (MES) project. As a member of the Medicaid Enterprise System (MES) Program within the Product Management space, you will collaborate with the product manager to champion key strategies that aim to improve healthcare outcomes for citizens through clinical and technological innovation. Your primary responsibility will be to provide independent product oversight for Organization Medicaid, specifically focusing on Pharmacy Benefits Management (PBM).

In this role, you will utilize your expert knowledge of Medicaid Pharmacy Benefits Management processes, roles, and intended outcomes to develop and monitor Medicaid Managed Care product strategies. You will collaborate with other Organization divisions and external stakeholders to streamline processes and implement targeted strategies. Your work will involve creating business process documents, user stories, business case scenarios, user acceptance test case scenarios, and conducting research to support Medicaid initiatives and strategic goals. Additionally, you will interact with various organization divisions and stakeholders, ensuring effective representation of organization business functions within Medicaid and the Product Management Space.

Roles and Responsibilities

Assists in cross-functional activities aimed at effectively overseeing Medicaid Programs. • Collaborates closely with the Product Manager to establish direct and hybrid reporting relationships and staff, prioritize tasks, assign accountabilities, and define roles/responsibilities to obtain necessary resources not under direct supervision, while ensuring optimal performance and compliance levels.
Engages and communicates with workgroups, including Product Managers, Product Owners, and Business Leads, to deliver product outcomes.
Possesses extensive knowledge and comprehension of products across healthcare functions and business segments that align with departmental objectives.
Conducts research and provides recommendations for the development and implementation of new product initiatives, including enhancements to existing products. • Offers feedback and input to senior decision-makers to devise long-term strategic options for product solutions.
Demonstrates experience in Medicaid/Healthcare and/or Managed Care domains.
Exhibits a strong understanding of the CMS MITA Framework encompassing Medicaid Business Architecture, Information Architecture, and Technical Architecture initiatives and activities.
Previously involved in Medicaid applications, preferably in Pharmacy Functional Areas.
Confirms business owners’ needs through various communication and meeting methods, translating them into detailed and actionable requirements when necessary.
Delivers in-person, conference call, or virtual training sessions on product knowledge, usage, and implementation.
Proficient in documenting database queries to analyze performance indicators, assess survey data, and define success criteria for testing and product acceptance.
Ensures compliance with all relevant policies and procedures.
Supports the product lifecycle from concept to implementation.
Evaluates emerging products and partners to gauge their potential value or risk to the department, providing recommendations on which modern technologies to invest in or leverage.
Adheres to Product Management guidelines.
Researches and gathers information required by the Product Manager to evaluate and analyze the work conducted by Medicaid Subject Matter Experts (SMEs), Business and Technical Leads, Data Leads, Engineers, and Architects, ensuring that the requested business capabilities, implemented design, and delivered functionality meet the stakeholders’ needs.
Familiarity with the CMS Certification process.
Performs additional assigned duties.

  • 7 years of experience in the Enterprise IT Systems integration principle and associated change management best practices.
  • 7 years of experience in Skills in persuasion, negotiation, relationship management, conflict resolution, and effective oral and written communication at all levels
  • 7 years of experience creating business use cases, requirements, and process maps/data floes
  • 7 years if experience to manage multiple priorities and projects, and function in a fast passed moving constantly changing, deadline-driven environment
  • Medicaid Pharmacy (PBM) processes: 3 years (Required)
  • Cloud technologies Iaas, Paas, Saas: 1 year (Preferred)
  • agile development methodologies, environment, and tools: 1 year (Preferred)
Pay Range – DOE. Benefits are per company policy