PBM Enforcement Manager (Program Management II): DORA/Division of Insurance.

Department Information

Hybrid Workplace Arrangement

Although this position will be designated under the department’s hybrid workplace program, it will still be required to report to the department office on a scheduled basis and at the discretion of the supervisor, based on business need.

The salary range posted for this position is Q1 $7,834 - Q3 $10,180 /monthly; although a salary range is listed, hiring salary will be set commensurate with the successful candidate's qualifications and in compliance with the Equal Pay for Equal Work Act.

This announcement may be used to fill multiple vacancies.

The Department of Regulatory Agencies (DORA) is dedicated to preserving the integrity of the marketplace and is committed to promoting a fair and competitive business environment in Colorado.

Consumer protection is our mission.

DORA values and promotes diversity, supporting a workplace that is inclusive of people from different backgrounds and experiences; creating an environment that is reflective of our communities; promoting positive relationships; and putting forth unique perspectives to fulfill our mission.

• Employer-sponsored RTD EcoPass, with offices located at Civic Center Plaza, above the RTD Civic Center station and just a few blocks from RTD light rail.
• Extensive work-life programs such as flexible schedules, training and professional development opportunities on a wide variety of subjects, and more!
• Employee wellness programs, including the Colorado State Employee Assistance Program (CSEAP), which provides free, confidential counseling services.
• Bike-to-work programs, including access to storage lockers and bike racks.
• Flexible retirement benefits, including a choice of the PERA Defined Benefit Plan or the PERA Defined Contribution Plan, plus optional 401K and 457 plans.
• Medical and Dental Health Insurance for employees and optional coverage for their dependents.
• Life Insurance for employees, and optional coverage for their dependents.
• Paid Time Off, including 11 paid holidays.
• Short- and long-term disability coverage.
• Tuition assistance program.
  
  

Check out our excellent benefits package!

Description Of Job

The Colorado Division of Insurance (DOI) regulates the insurance industry in Colorado by helping consumers by answering their questions, investigating their complaints, and helping them to understand their insurance. The Division regulates and monitors the insurance companies in Colorado, as well as insurance agents, ensuring all are following the law.

Position: SFA 4326

Requirements

The primary purpose of this position is to implement new pharmacy benefit manager (PBM) enforcement programs within the DOI, including HB 23-1227- PBM enforcement, HB23-1201- spread pricing, SB 23-195- copay accumulators from the 2023 legislation session, and HB22-1370- coverage requirements for health-care products from the 2022 session. The position manages the life cycle of the PBM programs and supervises the newly created PBM enforcement unit; makes evidence-based recommendations to the Commissioner and Deputy Commissioners to improve PBM programs and overall enforcement of PBMs. The position is the lead subject matter expert on PBMs within DOI and DORA. The position leads efforts on PBM enforcement and is the statewide authority on commercial market enforcement issues as they relate to PBMs. Duties include, but are not limited to:

• Working with the division leadership to successfully and strategically drive the division’s mission and goals as they relate to the implementation of HB 23-1227 (PBM enforcement), HB23-1201 (spread pricing), and SB23-195 (copay accumulators);
• Consulting with regulatory experts nationally and in other states who implemented or are considering implementing similar programs to identify best practices around PBM enforcement and spread pricing;
• Facilitating communication between division senior leadership and external stakeholders regarding the details of the PBM programs and supporting the development of a strong knowledge base around the programs internally and externally;
• Establishing guidelines for the PBM programs to maintain compliance with federal and state laws;
• Planning timelines to ensure milestones and deliverables are met; collaborating with other states operating PBM enforcement programs to share best practices; managing effective technological implementation of systems affecting the PBM enforcement program and ensuring completeness and accuracy of financial reporting; managing contracts and vendors to support the program and partnering with the finance department, DOI, DORA’s Office of Accounting and Purchasing, and Budget Office within DORA to ensure accuracy of all financial information needed to operate the program;
• Supervising staff members (including pay, status, and tenure) and contributing to the evaluation of their activities and performance, including hiring, performance management, setting goals, objectives, and plans; evaluating the services provided to internal and external customers, including providing accountability for the employees' productivity and overall performance;
• Drafting, updating, and finalizing regulations needed to implement HB 23-1227 and sustaining the division’s enforcement work of PBMs; coordinating with staff members in the division on the drafting, updating, and finalizing regulations that impact both the PBM enforcement team and other division teams;
• Working across the division and with DORA’s Office of Accounting and Purchasing and Budget Office to ensure successful collection of all associated fees and that the fees collected are used in accordance with state laws to operate the program;
• Coordinating with the director of life & health consumer services and the director of market conduct on complaints received about PBMs or where PBMs are a party to a complaint received by the division.
  
  

MINIMUM QUALIFICATIONS (MQs)

Minimum Qualifications, Substitutions, Conditions of Employment & Appeal Rights

• Graduation from an accredited college or university with a bachelor’s degree in business administration, public administration, law, economics or in a field of study related to the work assignment; AND

• Five (5) years of professional* work experience in a private or public healthcare-related industry, health insurance industry, and/or in a government agency performing all of the following functions:
• Policy and data analysis: experience in development and analysis of public policy or healthcare, and/or health insurance policy, including identification of economic impacts, implementation issues, and regulatory requirements. This experience must also include presenting on such analysis to senior leadership;
• Program Management: managing and effectively prioritizing multiple projects, including monitoring and driving progress, and reporting outcomes, as well as coordinating alignment between governmental agencies and partner organizations regarding improving healthcare affordability.
• Professional work involves exercising discretion, analytical skill, judgment and personal accountability and responsibility for creating, developing, integrating, applying, and sharing an organized body of knowledge that characteristically is: uniquely acquired through an intense education or training regimen at a recognized college or university; equivalent to the curriculum requirements for a bachelor's or higher degree with major study in or pertinent to the specialized field; and continuously studied to explore, extend, and use additional discoveries, interpretations, and application and to improve data, materials, equipment, applications and methods.
  
  
Document this experience in your application IN DETAIL, as your experience will not be inferred or assumed. Part time experience will be prorated.

Substitutions


• A combination of professional work experience in the occupational field or specialized subject area of the work assigned to the job, which provided the same kind, amount and level of knowledge acquired in the required education, may be substituted on a year-for-year basis for the bachelor's degree.
• A master's or doctorate degree from an accredited college or university in a field of study related to the work assignment may be substituted for two (2) years of the professional* experience.
  
  
Preferred Qualifications/Competencies


• Master’s or doctorate degree in business administration, public administration, healthcare administration, healthcare management, public policy, public health, health economics, or project management;
• Project management experience, including organizational skills, prioritization, and delegating of tasks to other team members;
• Experience overseeing policy development related to healthcare reform under both state and federal laws;
• Experience engaging and educating communities regarding improved access to integrated healthcare;
• Experience promoting the efficient use of policy and regulatory levers to address barriers and create opportunities to advance healthcare transformation efforts;
• Experience advising stakeholders (i.e. political/department leader) or commissioners on healthcare policy matters;
• Experience with pharmacy claims and data analysis;
• Experience in enforcing or regulating pharmacy benefit manager (PBM).
  
  
Required Competencies: The following knowledge, skills, abilities, and personal characteristics are required competencies and may be considered during the selection process (including examination and/or interview):


• Relationship management skills, to establish strong working relationships with stakeholders to ensure collaboration, data exchange, and joint development of performance improvement strategies;
• Demonstrated ability to conduct research and gather pertinent information;
• Ability to research, analyze and consistently apply state and federal insurance laws, rules, regulations and policies, including interpreting them in order to explain them to various stakeholders;
• Demonstrated understanding of how to effectively function in state government, along with the ability to build consensus in a complex and high-pressured, politically-charged environment;
• Flexibility and adaptability with regard to change management, including the ability to adhere to changes in work processes, adapt to changing priorities, and maintain a willingness to comply with and support organizational change(s);
• Demonstrated ability to understand and abide by workplace principles, practices and behaviors as internally identified and defined by the division;
• Ability to represent the department and the Division of Insurance in a positive, professional and objective manner, and support a positive workplace environment;
• Ability to handle sensitive and/or highly confidential information in a professional and ethical manner, and in accordance with state and federal laws;
• Strategic thinking, including the ability to identify emerging issues, anticipate trends, and provide recommendations on strategies to minimize risk impacts;
• Demonstrated understanding of quality customer service, including the ability to diplomatically deal with difficult customer interactions;
• Demonstrated interpersonal skills and the ability to work effectively on collaborative, multi-disciplinary teams;
• Demonstrated time management skills, including the ability to manage competing priorities and meet hard deadlines;
• Oral communication skills, including the ability to verbally communicate effectively to a diverse audience;
• Written communication skills, including the ability to complete reports in a clear, accurate, and concise manner;
• Demonstrated attention to detail;
• Professional demeanor;
• Proficiency in the use of various PC software applications including Microsoft Office (Access, Word, Excel, etc.), and Google Suite.
  
  
Conditions of Employment: Candidates who fail to meet the conditions of employment will be removed from consideration.

• The successful passing of a reference check and/or, if required, a background check.
• A reference check may include but is not limited to: contacting previous and current supervisors to verify employment and discuss performance, a review of the personnel file, a review of the performance record, a review of job-related public information, etc.
• The type of background check depends on the job duties of the position, and can include a review of any criminal record, credit report, and/or driving record.
• Ability to travel independently, including work in-office, as required by business need and scheduled by the supervisor.
• Effective September 20, 2021, employees will be required to attest to and verify whether or not they are fully vaccinated for COVID-19. Employees who have not been fully vaccinated may be required to submit to serial testing in the future. Upon hire, new employees will have three (3) business days to provide attestation to their status with proof of vaccination. Vaccinated employees must provide proof of vaccination.
• Note: Fully Vaccinated means two (2) weeks after a second dose in a two-dose series of the COVID-19 vaccine, such as the Pfizer or Moderna vaccine, or two (2) weeks after the single-dose vaccine, such as Johnson & Johnson’s Janssen vaccine, as defined by the most recent State of Colorado’s Public Health Order and current guidance issued by the Colorado Department of Public Health & Environment.
  

Supplemental Information

PLEASE READ - Required Application Materials

Interested individuals must submit the following online:

• A completed State of Colorado Application (log-in to your current NeoGov account or create a NeoGov account to complete the online application). Note: Incomplete applications, including incomplete work history sections or "see résumé," "see attachment," or "see addendum" statements, will not be accepted in lieu of a completed application form.
• A current email address on your application, as all communication pertaining to this position will be conducted via email. Please set up your email to accept messages from info@governmentjobs.com and '@state.co.us' addresses, and check your email often. Note: The department cannot guarantee the successful delivery of email, including incorrect filtering into junk mail folders.
• A detailed cover letter, explaining how you meet the required competencies and how your accomplishments, qualifications, skills, areas of expertise, personal characteristics, etc. make you a good fit for this position; you may also attach additional documents that demonstrate this.
  
  

Comparative Analysis Process: Structured Application Review

Part of, if not the entire, comparative analysis process for this position will involve a review of the information you submit in your application materials; Therefore, it is paramount that in the experience portion of your application and cover letter, you describe the extent to which you possess the education, experience, and competencies outlined in the job announcement as well as the required and/or preferred qualifications/competencies. You are also encouraged to attach additional documents to that effect. Failure to include adequate information or follow instructions may affect your score and prevent you from competing in subsequent measures used to arrive at a top group of applicants.

Veterans' Preference: Candidates who wish to assert Veterans' Preference should attach a copy of their DD-214 to their application. Failure to do so will result in being denied Veterans Preference.

PLEASE NOTE: Former State Personnel System employees who were disciplinarily terminated or resigned in lieu of termination must disclose this information on the application. Colorado Revised Statutes require that all state employees be hired and promoted through competitive examination of merit and fitness. Failure to include the required information, failure to follow instructions, and/or failure to submit materials by the application deadline may result in your application not being considered for the position and may affect your score or inclusion in the final pool of qualified candidates.

The State of Colorado believes that equity, diversity, and inclusion drive our success, and

we encourage candidates from all identities, backgrounds, and abilities to apply. The State

of Colorado is an equal opportunity employer committed to building inclusive, innovative

work environments with employees who reflect our communities and enthusiastically serve

them. Therefore, in all aspects of the employment process, we provide employment opportunities to

all qualified applicants without regard to race, color, religion, sex, disability, age, sexual orientation, gender identity or expression, pregnancy, medical condition related to pregnancy, creed, ancestry, national origin, marital status, genetic information, or military status (with preference given to military veterans), or any other protected status in accordance with applicable law.

DORA is committed to the full inclusion of all qualified individuals. As part of this

commitment, our agency will assist individuals who have a disability with any reasonable

accommodation requests related to employment, including completing the application

process, interviewing, completing any pre-employment testing, participating in the

employee selection process, and/or to perform essential job functions where the requested

accommodation does not impose an undue hardship. If you have a disability and require

reasonable accommodation to ensure you have a positive experience applying or interviewing for this position, please direct your inquiries to our ADAAA Coordinator, Rachael Alkayali, at dora_hr@state.co.us or call (303) 894-2441.

Appeal Rights

If you receive notice that you have been eliminated from consideration for this position, you may file an appeal with the State Personnel Board or request a review by the State Personnel Director.

An appeal or review must be submitted on the official appeal form, signed by you or your representative. This form must be delivered to the State Personnel Board by email, US Mail, faxed or hand-delivered within ten (10) calendar days from your receipt of notice or acknowledgment of the department’s action.

For more information about the appeals process, the official appeal form, and how to deliver it to the State Personnel Board go to spb.colorado.gov or refer to 4 Colorado Code of Regulations (CCR) 801-1, State Personnel Board Rules and Personnel Director's Administrative Procedures , Chapter 8, Resolution of Appeals and Disputes , at spb.colorado.gov under Rules.