Market Regulation PBM Compliance Consultant

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.

Market Regulation PBM Compliance Consultant

Position is work from home

Risk & Regulatory Consulting, LLC

Specific Duties and Responsibilities:

• Assess PBM and insurance company’s (Entity) compliance with state and federal laws.  Understanding of the Entities operations in relation to the insurance transactions and pharmaceutical supply chain is essential.  
• Evaluate Entities contracts with health plans and pharmacies to determine if they contain discriminatory or non-compliant provisions
• Perform comparative reviews of MAC pricing lists/contracts
• Conduct reviews of Entities’ insurance transactions with consumers to determine compliance with state and federal laws.  
• Conduct reimbursement methodology reviews, pharmacy audit reviews and network adequacy reviews
• Validate and analyze the quarterly and annual data reports
• Monitor Entities marketplace activities and trends
• 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 5 years of insurance company and/or PBM operational and/or compliance/internal audit experience and prior consulting experience in healthcare, managed care, or PBM industries and working knowledge of Pharmacy Benefit Managed Care business or PBM experience
• Bachelor’s Degree in Business, Risk Management, Accounting, Finance or applicable fields
• Ability to interact effectively across department lines and with all levels of management
• Must understand the fundamentals of health insurance and the pharmaceutical supply chain, MAC pricing, national average drug acquisition cost (NADAC) reimbursements, spread pricing, and pharmacy claims and balancing clinical, regulatory, pharmaceutical industry issues.
• Proficient at using Microsoft Office (Word, Excel, Access, PowerPoint, and Outlook)
• Effective written and oral communication skills
• Regulatory experience is a plus
• Strong analytical abilities and attention to detail
• Self-directed and the ability to problem solve in a positive, productive manner
• Strong communication skills, collaborative, adaptable to changing priorities and ability to execute on tight deadlines Strong team orientation and the ability to work with a variety of people
• Must be comfortable doing presentations and conducting phone calls with multiple team members
• Travel as needed 

Preferences:

• Have or work towards market regulation insurance designations, i.e., Certified Insurance Examiner (CIE), Accredited Insurance Examiner (AIE), Market Conduct Management (MCM)

Risk & Regulatory Consulting, LLC (RRC) was formerly a business segment of RSM US LLP (formerly McGladrey) until 2012 when the separate legal entity was formed.  RRC is a strategic business partner with RSM providing actuarial and insurance industry consulting services to RSM clients.

Risk & Regulatory Consulting, LLC (RRC) is a national, leading professional services firm dedicated to providing exceptional regulatory services to clients. With over 120 experienced insurance professionals located in 22 states, we believe RRC is uniquely positioned to serve state insurance departments. We offer services in the following regulatory areas: financial examinations, market conduct examinations, insolvency and receiverships, actuarial services and valuations, investment analysis, reinsurance expertise, market analysis and compliance, and special projects. We are a results oriented firm committed to success that builds long term relationships with our clients. 

RRC is managed by seven partners and our practice includes full time professionals dedicated to our regulatory clients. We are focused on listening to your needs and designing customized examination, consulting, and training solutions that address your needs. We bring multiple service lines together to provide superior and seamless service to our clients. We are committed to training our customers and our team. We have developed various comprehensive in house training programs that have been tailored to meet the needs of our regulatory clients. We offer competitive pricing, outstanding experience, credentials and references. RRC is an active participant in the NAIC, SOFE, and IRES.

At RSM, we offer a competitive benefits and compensation package for all our people. 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 https://rsmus.com/careers/working-at-rsm/benefits.

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; US Military/Veteran status; 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 careers@rsmus.com.

RSM does not intend to hire entry level candidates who will require sponsorship now OR in the future (i.e. F-1 visa holders). If you are a recent U.S. college / university graduate possessing 1-2 years of progressive and relevant work experience in a same or similar role to the one for which you are applying, excluding internships, you may be eligible for hire as an experienced associate.

RSM will consider for employment qualified applicants with arrest or conviction records in accordance with the requirements of applicable law, including but not limited to, the California Fair Chance Act, the Los Angeles Fair Chance Initiative for Hiring Ordinance, the Los Angeles County Fair Chance Ordinance for Employers, and the San Francisco Fair Chance Ordinance. For additional information regarding RSM’s background check process, including information about job duties that necessitate the use of one or more types of background checks, click here.

At RSM, an employee’s pay at any point in their career is intended to reflect their experiences, performance, and skills for their current role. The salary range (or starting rate for interns and associates) for this role represents numerous factors considered in the hiring decisions including, but not limited to, education, skills, work experience, certifications, location, etc. As such, pay for the successful candidate(s) could fall anywhere within the stated range.