What are the responsibilities and job description for the VIVA HEALTH | Senior PBM Oversight Coordinator position at VIVA HEALTH?
Senior PBM (Pharmacy Benefit Manager) Oversight Coordinator
Location : Birmingham, AL
Work Schedule : This is a hybrid position with regular work performed at the VIVA HEALTH corporate headquarters in downtown Birmingham and some work-from-home opportunities.
Why VIVA HEALTH?
VIVA HEALTH, part of the renowned University of Alabama at Birmingham (UAB) Health System, is a health maintenance organization providing quality, accessible health care. Our employees are a part of the communities they serve and proudly partner with members on their healthcare journeys.
VIVA HEALTH has consistently been recognized by Centers for Medicare & Medicaid Services (CMS) as a high-performing health plan and has been repeatedly ranked as one of the nation's Best Places to Work by Modern Healthcare.
Job Description
The Senior Pharmacy Benefit Manager Oversight Coordinator is responsible for the overall management and health plan oversight of our Pharmacy Benefit Managers (PBMs) and pharmacy operations related services (through the PBM directly, as well as vendors contracted directly or through the PBM) for all lines of business including Medicare and Commercial. This role includes services provided and applicable to both the pharmacy drug benefit and the medical drug benefit. This position works collaboratively with the PBM, outside consulting firms, and other internal stakeholders to ensure that the PBM is meeting financial and business obligations as well as contractual and compliance requirements.
This individual will serve as the primary day to day contact and be accountable for managing all Request for Proposal (RFP) projects, plan and program implementations, contract negotiations, and performance and issue management functions related to the PBMs.
Key Responsibilities
- Coordinate the selection and contracting of a qualified consulting firm to facilitate PBM requests for proposals, annual market checks, and PBM audits and serves as the consultant’s primary point of contact.
- Ensure market checks and RFPs are conducted in a timely to manner to maximize health plan leverage during contract negotiations and coordinates timely follow-up during the back and forth review of contract terms.
- Oversee PBM contract negotiations and maintain accountability for the PBM contracts in place. Serve as the subject matter expert for the health plan’s PBM agreements.
- Monitor the financial terms of the PBM agreements versus benchmarks and stay abreast of best practices in PBM negotiations to reduce health plan expense and increase service levels.
- Monitor and audit PBM performance on core functions and any additional programs the health plan elects to ensure compliance with contract terms, health plan service level expectations, and regulatory requirements. Maintain key metrics needed for PBM oversight and contract negotiation.
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