Summary
 

Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but for more than seven decades we’ve been part of the national landscape, with our roots firmly embedded in the South Carolina community. We are the largest insurance company in South Carolina … and much more. We are one of the nation’s leading administrators of government contracts. We operate one of the most sophisticated data processing centers in the Southeast. We also have a diverse family of subsidiary companies that allows us to build on a variety of business strengths. We deliver outstanding service to our customers. If you are dedicated to the same philosophy, consider joining our team!

Description
 

Position Purpose:

Support the Director of Pharmacy Administration and Oversight by executing all aspects of the contract management process, including production and oversight of PBM Addenda and Non-Disclosure Agreements, coordination of self-fund group pharmacy audit activities and requests for market check evaluations, and/or activities required to support the contract management and oversight for the Corporate PBM Agreements and/or other Pharmacy Services vendor Agreements. Serve as primary point of contact for pharmacy related legal documents, rate/pricing management and other related needs. Regularly provides feedback and recommendations to Legal, Compliance, Pharmacy Leadership, and senior leadership in the Private Business Division.

What You’ll Do:

• Review, develop, redline, and negotiate Corporate PBM Agreements, Addenda and Amendments, Pharmacy Services vendor Agreements and/or PBM Addenda for self-funded commercial clients across the Enterprise, in cooperation with management, legal, internal stakeholders, and external business partners. Negotiate rates, value adds, service level agreements (SLA) and other legal and business terms.
• Review, develop, redline, and negotiate third-party vendor contracts, including Master Service Agreements (MSA), Statement of Work (SOW), Non-Disclosure Agreements (NDA) and amendments in cooperation with legal, internal stakeholders, and external business partners. Negotiate rates, value adds, service level agreements (SLA) and other legal and business terms.
• Create, implement, and oversee oversight programs to measure on-going compliance with Corporate PBM Agreement, Pharmacy Services vendor Agreements and/or PBM Addenda for self-funded commercial clients across the Enterprise, in cooperation with management, legal, internal stakeholders, and external business partners.
• Coordinates all activities of corporate or self-funded employer PBM proposal development as assigned by management.  Responsible for understanding, and verbally articulating detailed analysis of RFPS, RFIS, RFQS, as well as other documents. Collaborates with Subject Matter Experts (SME), and other staff to create a high quality, winning proposal response.   Coordinates overall proposal process to include intake of customer requests, creating documentation to accompany delegation of required activities to complete proposals, creating and maintaining timeline of activities and packaging the final product for return to customer. May assist with sales support activities such as preparing/giving presentations to prospective customers, etc.
• Partner with Legal, Finance, Books and Contracts and other business units to minimize and mitigate risk. In collaboration with internal stakeholders, develop and lead, key supplier Quarterly Business Review (QBR) process. Ensure compliance with all government regulations and internal policies and procedures.
• Create project plans to manage and execute all assigned projects.

To Qualify for This Position, You’ll Need:

Required Education:

• Bachelor's degree

Required Work Experience:

• 8 years in health-plan/healthcare/pharmacy contracting, PBM contracting and/or healthcare auditing, oversight and/or compliance.

Degree Equivalency:

• Associate's plus an added 2 years job related work experience for a total of 10 years required work experience.

OR

• 12 Years required job-related work experience

Required Skills and Abilities:

• Advanced knowledge of pharmacy business support and systems concepts.
• Knowledge in contracting and regulatory oversight, linking to business processes. 
• Excellent verbal and written communication and presentation skills to be used with technical and non-technical audiences, including the ability to express complex technical and business concepts to management, peers, and the business units.
• Time management skills and the ability to work effectively in an independent setting. 
• Good organization and ability to handle multiple complex projects with competing deadlines. 

Required Software and Other Tools:

• Microsoft Office

What we Prefer you to have:

• Master's Degree
• 10 years in experience in healthcare/PBM/regulatory/compliance agency contracting and/or oversight/audit
• Paralegal/legal assistant experience and/or PBM oversight experience
• Paralegal certification

What We can Do for You:

We offer our employees great benefits and rewards.  You will be eligible to participate in the benefits the first of the month following 28 days of employment.  

• Subsidized health plans, dental and vision coverage
• 401K retirement savings plan with company match
• Life Insurance
• Paid Time Off (PTO)
• On-site cafeterias and fitness centers in major locations
• Wellness program and healthy lifestyle premium discount
• Tuition assistance
• Service recognition
• Employee Assistance
• Discounts to movies, theaters, zoos, theme parks and more

What to Expect Next:

After submitting your application, our recruiting team members will review your resume to ensure your meet the qualifications.  This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements. If the qualifications required proof of semester hours, please attach your transcript to your application.

Management will be conducting interviews with the most qualified candidates, with prioritization give to those candidates who demonstrate the preferred qualifications.

 

We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer.

Some states have required notifications. Here's more information. 

Equal Employment Opportunity Statement

BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains Affirmative Action programs to promote employment opportunities for minorities, females, disabled individuals and veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations.

We are committed to working with and providing reasonable accommodations to individuals with physical and mental disabilities.

If you need special assistance or an accommodation while seeking employment, please e-mail [email protected] or call 1-800-288-2227, ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis.