Job Description

Description and Functions

Open Until Filled

GENERAL DESCRIPTION:

This individual is responsible for creating and managing all aspects of the Department of Insurance\'s pharmacy benefit manager oversight program including creating policies and guidelines based on statutes to handle registration, complaints, and investigations. This position communicates with pharmacists, pharmacy benefit managers, and insurance companies to ensure compliance with Wyoming law. This position will have supervisory responsibilities over a small to medium size staff and is responsible for setting and controlling a budget.

Human Resource Contact: Alice Saldana / / 307-777-7667

ESSENTIAL FUNCTIONS: The listed functions are illustrative only and are not intended to describe every function which may be performed in the job level.

• Provide the Pharmacy Benefit Manager (PBM) program with oversight and creation.
• Ensure DOI has adequate resources to handle PBM-related issues.
• Manage requests for proposal (RFP) process and works with Staff Attorney in contracting with entities for training, investigation, and complaint-related services.
• Manage work product and day-to-day tasks of contractors.
• Create PBM internal policies and procedures based on Wyoming Law and research from other states for the purposes of licensure, complaints, and investigations related to pharmacy benefit managers.
• Handle PBM licensing process and oversees all PBM-related complaints.
• Communicate with insurance companies, PBMs, pharmacists, and stakeholders related to complaints.
• Research, investigate, and examine PBM complaint data and information.
• Resolve complaints and track data and trends related to complaint issues.
• Provides Technical expertise and information as it relates to all aspects of pharmacy benefit managers.
• Serve in an advisory capacity to company representatives, pharmacists, the Commissioner, and DOI staff on the interpretation of PBM issues.
• Track and analyze trends related to legislation, complaints, processes, and investigations involving pharmacy benefit managers.
• Research and create consumer and industry-directed outreach and education related to pharmacy benefit manager law, regulation, policies, procedures, and federal law updates.
• Research and create proposed legislation and rules related to pharmacy benefit managers.
• Represent the DOI and testify at legislative committee meetings, national insurance meetings, and seminars.
• Defines unit goals, and priorities and develops implementation action plans for subordinate staff to maintain the flow of work and timely deliverables. Within the scope of available resources, provides for employee education and development.
• Ensures that quality program compliance, customer service, and correct information are provided to program clients and agency staff.

Qualifications

PREFERENCES/**AGENCY REQUIREMENTS:

Preference may be given to Pharmacists or technicians with extensive knowledge of pharmacy benefit managers and insurance.

**Must possess a valid driver\'s license.

KNOWLEDGE:

• Knowledge of pharmacy benefit managers, pharmacy claims, pharmacy third-party payer relationships, and the pharmaceutical supply chain.
• Knowledge of legislative process.
• Excellent written and verbal communication skills are required.
• Self-motivated and excellent time management are required.
• Ability to research, present, interpret, and apply legislation and rules.
• Excellent analytical and research skills, attention to detail, and critical thinking skills are required.
• Ability to manage work, provide guidance to internal staff and external stakeholders, make presentations, and prepare reports.

MINIMUM QUALIFICATIONS:

Education:

Bachelor\'s Degree (typically in Healthcare)

Experience:

1-3 years of progressive work experience (typically in Health Programs) with acquired knowledge at the level of a Health Program Supervisor

OR

Education & Experience Substitution:

4-7 years of progressive work experience (typically in Health Programs) with acquired knowledge at the level of a Health Program Supervisor

Certificates, Licenses, Registrations:

None

Necessary Special Requirements

PHYSICAL WORKING CONDITIONS:

• Typically, the employee will sit comfortably to perform the work, however, there may be some walking, standing, bending, and carrying light items.
• Travel may be required.

NOTES:

• FLSA: Exempt

Supplemental Information

044-Insurance Department

Click to view the State of Wyoming Classification and Pay Structure.

URL:

The State of Wyoming is an Equal Opportunity Employer and actively supports the ADA and reasonably accommodates qualified applicants with disabilities.

Class Specifications are subject to change, please refer to the A & I HRD Website to ensure that you have the most recent version.

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