We are the leading provider of professional services to the middle market globally, our purpose is to instill confidence in a world of change, empowering our clients and people to realize their full potential. Our exceptional people are the key to our unrivaled, inclusive culture and talent experience and our ability to be compelling to our clients. You'll find an environment that inspires and empowers you to thrive both personally and professionally. There's no one like you and that's why there's nowhere like RSM.

Pharmacist Consultant

Position is work from home

Risk & Regulatory Consulting, LLC

Specific Duties and Responsibilities:

• Assess issuer/insurer compliance with market-wide requirements of ACA, MHPAEA, and state laws, including prescription drug formularies and design thereof and pharmacy claims benefits, including mandated benefits. Experience with PBMs a plus
• Document in writing findings and reports of examinations, as needed
• Prepare and present training on such topics
• Participate in practice development activities with state and federal state agencies

Requirements:

• Must have 15+ years of pharmacy experience as a registered pharmacist in the regulatory, insurance or healthcare industry or consulting industry, behavioral health, retail and/or clinical fields.
• Must have 10+ years of Pharmacy Benefits Management (PBM) experience
• PharmD is required
• Strongly prefer candidates with state insurance or state health agency experience, CMS (Center for Medicare and Medicaid Services) and/or Office of Personnel Management experience
• Must have experience with formulary reviews, pharmacy claims audits, auditing formularies and experience with formulary medication system
• Experience running CMS formulary tools is a must along with review of formulary filings with state and federal agencies
• Previous experience with formulary medication systems development to support process improvement strategies is helpful
• Effectively use information technology (IT) to analyze data in areas of evidence based medicine practices, outcomes measurements, and process improvements
• Must be able to interact with multi-disciplinary team of experts in areas of IT, health insurance, pharmacy, market regulation and healthcare policy
• Must understand the fundamentals of pharmacy financial data and balancing clinical, regulatory, pharmaceutical industry and consumer access issues to formulary system development
• Must be able to contribute decision support for system refinements pertinent to improving formulary review, optimizing review tools, and enhancing system performance.
• Claims processing experience in retail or managed care
• ACA and Mental Health Parity experience
• Experience with managed care RX expenses
• Proficient at using Microsoft Office (Word, Excel, Access, PowerPoint, and Outlook)
• Effective written and oral communication skills
• Must be able to meet tight deadlines and offer flexibility in hours
• Regulatory experience is a plus
• Strong writing skills
• Strong analytical abilities and attention to detail
• Experience and ability to work both independently and within a team environment - strong team player desired
• Ability to adapt to changing priorities, self-motivated and energetic qualities desirable
• Managed Care/Pharmacy Benefit Management and pharmacy audit experience preferred
• A combination of pharmaco-economic, drug information, clinical experience is highly desirable
• Must be comfortable doing presentations and conducting phone calls with multiple team members
• Travel as needed

At RSM, we offer a competitive benefits and compensation package for all our people. We support and inspire you to prioritize your wellbeing by delivering personalized, holistic programming for your physical, emotional, financial and community wellbeing. RSM has a generous time off policy with at least 14 paid holidays, wellbeing days and associate and above access to self-managed time off. We offer flexibility in your schedule, empowering you to balance life's demands, while also maintaining your ability to serve clients. Learn more about our total rewards at .

RSM is proud to be an Affirmative Action and Equal Employment Opportunity employer. We are proud to provide our employees with tools to assist them in being successful in achieving both personal and professional goals. We welcome and support all our employees to thrive in an environment free of discrimination and harassment. As an Affirmative Action and Equal Opportunity Employer all applicants will receive consideration for employment as RSM does not tolerate discrimination and/or harassment based on race; color; creed; sincerely held religious beliefs, practices or observances; sex (including pregnancy or disabilities related to nursing); gender (including gender identity and/or gender expression); sexual orientation; HIV Status; national origin; ancestry; familial or marital status; age; physical or mental disability; citizenship; political affiliation; medical condition (including family and medical leave); domestic violence victim status; past, current or prospective service in the US uniformed service; pre-disposing genetic characteristics or any other characteristic protected under applicable federal, state or local law.

Accommodation for applicants with disabilities is available upon request in connection with the recruitment process and/or employment/partnership. RSM is committed to providing equal opportunity and reasonable accommodation for people with disabilities. If you require a reasonable accommodation to complete an application, interview, or otherwise participate in the recruiting process, please call us at 800-274-3978 or send us an email at .

RSM does not intend to hire entry level candidates who will require sponsorship now OR in the future (i.e. F-1 visa holders). However, those candidates who may be recent U.S. college / university graduates possessing 1-2 years of progressive and relevant work experience, excluding internships, in the U.S. or his/her home country would be eligible for hire as an experienced candidate and thus eligible for sponsorship.