Lead, Pharmacy Credentialing Benefit Management (PCBM)
Location Miami, Florida, United States of America Category Human Resources Job Id R0017236
ChenMed is transforming healthcare for seniors. We provide big answers to big problems in health care delivery. ChenMed is a full-risk primary care market leader with an innovative philosophy, unique physician culture and end-to-end customized technology. These things allow us to provide world-class primary care and coordinated care to the most vulnerable population – moderate- to low-income seniors who have complex chronic diseases.
Through our innovative operating model, physician-led culture and empowering technology, we are able to drive key quality and cost outcomes that create value for patients, physicians and the overall health system. Our model allows us to practice medicine the way it should be practiced. By recruiting focused physicians and reducing their doctor-to-patient ratios, we increase patients’ “face time” during each monthly appointment and help foster stronger doctor-patient relationships. Our model also drives and enhances compliance with treatment plans.
As a result of our efforts, our patients realize lower hospital admissions. Their overwhelming response to our approach is reflected in our aggressive, organic growth and net promoter scores in the low to mid 90s, which is unheard of in any industry. Read more about our results and the value of the ChenMed model.
As a company, we are making a difference in the lives of seniors and the health care system overall.
ESSENTIAL JOB DUTIES/RESPONSIBILITIES:
- Leads effort to gather required information from internal departments and then complete and submit permit and licensing applications, and other submissions to state, federal, and local agencies as well as industry partners such as pharmacy benefit managers.
- Prepares and submits initial applications for expansion state licensing and renewal state licensing for all dispensaries.
- Attends new market and new payor calls to identify new dispensary builds, new payor contracts and/or payor initiated PBM changes to ensure identification of key PBM contacts to plan and initiate credentialing discussion.
- Schedules new PBM calls to confirm understanding of application and credentialing process.
- Maintains relationships with PBMs to ensure re-credentialing
- Maintains new dispensary setup and decommissioning in partnership with key market leaders.
- Manages communication with PBMs and ensures the execution of yearly compliance attestations and recredentialing requests.
- Coordinates and monitors credentialing and dispensing confirmation with Medication COE to ensure all centers are active and dispensing ready.
- Partners with Legal, Risk and Office of Chief Quality officer to execute contracts.
- Provides credentialing status updates to market leaders.
- Supports Credentialing Manager with new market projects.
- Identifies process improvement opportunities and presents recommendations to Credentialing Manager and other leadership stakeholders.
- Implements improvement opportunities by creating or updating documentation and training resources.
- Partners with market leaders to identify primary physician in charge at each location and is responsible for ensuring credentials are renewed and updated.
- Performs other duties as assigned and modified at manager’s discretion.
KNOWLEDGE, SKILLS AND ABILITIES:
- Knowledge of credentialing requirements such as NPI, NCPDP, DEA and HCCE
- Knowledge of local, state and federal dispensary regulatory guidelines or other relevant licensing processes and/or contracting
- Knowledge and understanding of the PBM credentialing process
- Strong analytical, problem solving skills are essential. Database management skills including querying, reporting and document generation
- Professional, motivated and pleasant demeanor
- Excellent organizational and follow-up skills with attention to detail and accuracy
- Ability to communicate effectively, both verbally and in writing
- Informational research skills
- Ability to organize and prioritize work and manage multiple priorities simultaneously to meet deadlines
- Ability to work independently with minimal supervision
- Ability to establish and maintain effective working relationships with external vendors/contacts and internal stakeholders including providers, management, staff
- Proficient in Microsoft Office Suite products including Word, Excel, PowerPoint and Outlook, plus a variety of other word-processing, spreadsheet, database, e-mail and presentation software
- Ability and willingness to travel locally, regionally and nationwide up to 10% of the time
- Spoken and written fluency in English
At ChenMed, If you are an innovative, entrepreneurial minded, over-achiever who is extremely passionate in helping people and revolutionizing Healthcare again, we are that dynamic and exciting company you are looking for!
After applying, we encourage you to "follow" us on LinkedIn (ChenMed) as well! This way you can stay informed and up to date on what’s happening around our organization and start your path to becoming part of our FAMILY!
EDUCATION AND EXPERIENCE CRITERIA:
- BA/BS degree in Healthcare Administration, Business Administration, Pharmaceutical Sciences or a related field OR additional experience above the minimum will be considered in lieu of the required education on a year-for-year basis required
- A minimum of 5 years work experience as a Pharmacy Technician, Pharmacy Credentialing Specialist or a similar role required
- Experience with PBM Credentialing, Applications and Contracts with ESI, CVS, OptumRx and others
The Lead, Pharmacy Credentialing Benefit Manager (PCBM) is responsible for leading the effort to secure licenses and permits from state and federal agencies, and industry contracts for our rapidly increasing number of new dispensaries. The incumbent in this role works directly with PBM contract counterparts to successfully manage the credentialing and recredentialing of new and existing center dispensaries. The Lead, PCBM is also accountable for assessing and providing continuous improvement recommendations for credentialing processes, co-facilitating improvement design sessions in coordination with Med COE, IT and NICU team members and training respective departments on processes and guidelines. He/She serves as the primary point of contact for resolving center questions and issues related to PBM contracts.
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Meet Our Team
David Guerra MD, Medical Director