Especialista En Alianza Para Medicos Especializados

GENERAL DESCRIPTION: Supports the planning, development, and execution of specialty pharmacy programs for both MCS lines of business. Responsible for monitoring and reporting to ensure established programs deliver the expected clinical and financial results. Ensures that specialty medication strategies achieve company goals and remain in compliance with regulatory agencies. ESSENTIAL FUNCTIONS: •Develops monitoring processes and metrics for pharmacy benefit and medical component programs for both lines of business related to specialty medications. •Performs analysis of clinical strategies for specialty medications such as pre-authorizations, quantity limits, step therapy, cost, and prescribing trends, among others. •Monitors and measures Effective Medical Cost Management with Electronic Medication Management (EMM) and clinical programs related to specialty medications. •Serves as a Specialty Medication Liaison with other operational areas of MCS (e.g., Formulary, Implementation, Product Development, Sales) for the status or clarification of pharmacy benefits related to specialty medications. •Serves as a subject matter expert in the management of specialty drugs programs, including pharmacy network, transaction analyses, and implementation processes. •Serves as a subject matter expert on financial assistance available to patients, ensuring eligible specialty medications are applied for financial assistance such as co-pay cards and discount programs. •Generates and provides reports as requested by management. ADDITIONAL FUNCTIONS: • Must comply fully and consistently with all company policies and procedures, with local and federal laws as well as with the regulations applicable to our Industry, to maintain appropriate business and employment practices. • May carry out other duties and responsibilities as assigned, according to the requirements of education and experience contained in this document. MINIMUM QUALIFICATIONS: Education and Experience: Bachelor's Degree in areas related to Natural Sciences and Health Services Management. At least two (2) years of experience in Pharmacy Benefit Management (PBM) or developing and tracking key performance indicators (KPIs), or formulary management, or utilization management, or specialty pharmacy programs, preferably within the Healthcare Insurance industry. OR Education and Experience: Associate’s Degree in Pharmacy Technician. At least four (4) years of experience in Pharmacy Benefit Management (PBM) or developing and tracking key performance indicators (KPIs), or formulary management, or utilization management, or specialty pharmacy programs, preferably within the Healthcare Insurance industry. “Proven experience may be replaced by previously established requirements.” Certifications / Licenses: For an Associate’s Degree, a valid License and Registration as a Pharmacy Technician is required. Other: Intermediate management of Excel. Familiarity with Electronic Medication Management (EMM) or similar clinical program tracking tools. Languages: Spanish – Advanced (comprehensive, writing and verbal) English – Intermediate (comprehensive, writing and verbal)