DIRECTOR OF INTERGOVERNMENTAL RELATIONS

State of careers Rhode Island

1d • $125,132 - $144,254 • Onsite

About The Position

The Administrator – Pharmacy Benefit Manager Regulation, under the direction of the Health Insurance Commissioner, will oversee the development, implementation, and administration of the Office of the Health Insurance Commissioner's (OHIC) Pharmacy Benefit Manager (PBM) regulatory program. The Administrator will provide leadership and technical expertise in the certification, regulation, and oversight of pharmacy benefit managers operating in Rhode Island to ensure compliance with applicable state laws and regulations and to promote transparency, accountability, consumer protection, and access to affordable prescription drug benefits.

Requirements

• Knowledge of regulatory compliance, administrative law, investigations, and enforcement.
• Ability to interpret complex statutes, regulations, and contracts.
• Excellent analytical, organizational, project management, and communication skills.
• Ability to establish productive relationships with regulated entities and stakeholders.
• Ability to manage multiple priorities and statutory deadlines.
• Ability to exercise sound judgment and independent decision-making.
• Graduation from a college of recognized standing with a bachelor's degree.
• A minimum of five (5) years of progressively responsible experience in health insurance regulation, pharmacy benefit management, healthcare policy, health law, compliance, insurance regulation, administrative law, litigation, or a related field.
• A master's degree, Juris Doctor, or other advanced degree may be substituted for a portion of the required experience.
• Any combination of education and experience substantially equivalent to the above qualifications will be considered.

Nice To Haves

• Knowledge of health insurance regulation, pharmacy benefit management, prescription drug benefit administration, and applicable laws preferred.
• Experience developing policies, regulations, or legislative recommendations preferred.
• A degree in Public Administration, Public Policy, Healthcare Administration, Business Administration, Pharmacy, Law, Finance, Economics, or a closely related field is preferred but not required.
• While candidates with a law degree are preferred

Responsibilities

• Administer the Pharmacy Benefit Manager Regulatory Program.
• Develop, implement, and oversee OHIC's PBM regulatory program.
• Review and evaluate applications for certificates of authority, renewals, amendments, and required submissions.
• Maintain certification records and oversee regulatory filings.
• Monitor PBM compliance with applicable laws and regulations.
• Review financial, operational, contractual, and compliance information.
• Coordinate complaint investigations, market conduct examinations, and compliance reviews in collaboration with internal and external subject matter experts.
• Recommend corrective actions and enforcement measures.
• Coordinate with legal counsel regarding investigations and enforcement.
• Assist with the drafting of regulations, bulletins, guidance documents, and policies.
• Monitor state and federal developments affecting PBMs.
• Recommend policy improvements.
• Advise the Commissioner regarding PBM policy and legislation.
• Serve as OHIC's primary liaison with PBMs, insurers, pharmacies, providers, consumers, and state agencies within the domain of PBMs.
• Provide technical assistance regarding statutory and regulatory requirements.
• Represent OHIC on workgroups, advisory committees, and public meetings as needed.
• Foster collaborative stakeholder relationships.
• Analyze data and prepare reports in collaboration with internal and external subject matter experts.
• Oversee consultants and vendors, as appropriate.
• Prepare executive correspondence and briefing materials.
• Perform other duties as assigned.

Benefits

• For information regarding the benefits available to State of Rhode Island employees, please visit the Office of Employee Benefits' website at http://www.employeebenefits.ri.gov/.
• Direct deposit for all employees.
• All employees hired after September 30, 2014 participate in direct deposit.

What This Job Offers

• Job Type: Full-time
• Career Level: Director