Business Analyst Project Management Experience HIPPA Communication Skills Specia

CoolsoftRaleigh, NC, United States

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Business Analyst Project Management Experience HIPPA Communication Skills Specialis

Requirement id 154808

Job title Specialist

Job location in Raleigh, NC

Skills required Adobe Software Products, not found, Business Analyst, Project Management Experience HIPPA Comm

Open Date 21-Aug-2025

Close Date

Job type Contract

Duration 9 Months

Compensation DOE

Status requirement

Job interview type

Email Recruiter : coolsoft

Job Description Specialist : Adobe Software Products, not found, Business Analyst, Project Management Experience HIPPA Comm

Start date : 08 / 25 / 2025

End Date : 05 / 19 / 2026

Submission deadline : 08 / 27 / 2025

Client Info : NCDHHS-HB

Note :

Agency Interview Type : Either Webcam Interview or In Person

Hybrid

Description :

The PBM Business Integration Specialist will serve as a member of the DHHS Medicaid Enterprise System (MES) Program within Pharmacy Business space. The PBM Business Integration Specialist will provide expertise and business support to the Pharmacy and Ancillary Services Business Unit in the development and implementation of the Medicaid Enterprise Modular Pharmacy Business Management (PBM) Solution. The PBM Business Integration Specialist, as a Business Subject Matter Expert, will assist the Department to on-board the PBM vendor, serve as a business stakeholder, and represent the Pharmacy Business Unit in the implementation of the complex and innovative PBM Solution.

The primary responsibility of this position is to serve as the subject matter expert and content lead in collaboration with the Pharmacy Business team for Clinical policies and Prior Authorizations, Drug Utilization Review (DUR) and pharmacy lock-in related processes, Behavioral health, and A+ kids, Preferred Drug List (PDL) and Medicaid Drug Rebate Program (MDRP), and Physicians Administered Drug Program (PADP) related to the Medicaid Drug Rebate Program (MDRP).

The Pharmacy team needs a Business Integration Specialist who is dedicated to the PBM Module Implementation and can focus on these work streams as they relate to implementation of the new PBM, in collaboration with the existing pharmacy team.

Knowledge of Medicaid Pharmacy Benefits Management processes, intended outcomes, and pain points is essential.

This position will actively work with the Pharmacy Business team to define and provide the business support in completing the business process documents, Business use cases, Business case scenarios, user acceptance test case scenarios, and documentation in relation to Medicaid initiatives and strategic goals. This position may require interacting with the NC Medicaid Business Information Analytics Office, DHHS Data Office, Information Technology Division, Privacy and Security Office, Policy Office, General Counsel, Office of Procurement, Contracts and Grants, among others.

Roles and Responsibilities

Supports one or more Pharmacy business process areas, including.

o Clinical policies and Prior Authorizations.

o Drug Utilization Review (DUR) and pharmacy lock-in related processes

o Behavioral health, and A+ kids.

o Preferred Drug List (PDL) and Medicaid Drug Rebate Program (MDRP)

o Physicians Administered Drug Program (PADP) related to the Medicaid Drug Rebate Program (MDRP)

Supports cross-functional activities that provide effective oversight of Medicaid Programs.

Collaborates and communicates with the PBM Business stakeholders (Product Managers, Product Owners, Business Leads.)

In-depth knowledge and understanding of the business needs across functions and business segments in healthcare that meet departmental goals.

Ability to research and recommend the development and implementation of business initiatives of the product enhancements.

Provides feedback and input to senior level decision-makers to develop long-range strategic alternatives for business solutions.

Preferred to have experience with Medicaid, managed care, and Pharmacy Benefit Manager (PBM) operations. areas.

Prior experience with Medicaid applications and preferably across Pharmacy Functional Areas.

Communicate with the business owner needs and help translate them into detailed and actionable requirements as needed.

Ensures compliance with all applicable policies and procedures.

Supporting the product lifecycle from conception through implementation.

Performs other duties

Call502-379-4456 Ext 100for more details. Please provide Requirement id : 154808 while calling.

EOE Protected Veterans / Disability

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Management Analyst • Raleigh, NC, United States