Job Description
The Connecticut Department of Social Services (DSS) is seeking a Pharmacy Benefit Administrator (PBA) Subject Matter Expert (SME) to support the Connecticut Medicaid Enterprise Technology System (CT METS), a multi-year Medicaid modernization initiative focused on transforming legacy Medicaid systems into a modern, modular Medicaid Enterprise System (MES). The PBA SME will play a critical role in the design, development, implementation (DDI), and ongoing maintenance and operations (M&O) of the new Pharmacy Benefit Administration module, ensuring that pharmacy business requirements, workflows, compliance obligations, and operational processes are successfully incorporated into the solution. This individual will serve as the primary pharmacy business expert, partnering closely with DSS leadership, CT METS program staff, operations teams, vendors, providers, and technical stakeholders to guide solution design, validate requirements, review deliverables, support testing activities, and ensure successful integration with other Medicaid Enterprise modules. The ideal candidate will leverage extensive Medicaid pharmacy and Pharmacy Benefit Administration experience to lead discussions, provide recommendations, support cross-module planning and interoperability efforts, and ensure alignment with CMS certification requirements, DSS policies, funding guidelines, and State priorities. Responsibilities include supporting pharmacy claims processing modernization, pharmacy transparency and cost avoidance initiatives, business process development, organizational change management activities, stakeholder engagement, issue resolution, compliance validation, vendor oversight, and implementation readiness to ensure the successful deployment and long-term operation of Connecticut's new Pharmacy Benefit Administration platform.
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Required Skills & Experience
• Bachelor’s degree in Business, Public Administration, a related field or comparable work experience.
• Strong understanding of Medicaid programs and CMS oversight.
• Minimum of six years of extensive PBA experience.
• Experience with engaging large stakeholder groups.
• Excellent organization, analytic and communication skills.
Nice to Have Skills & Experience
• Experience with State Medicaid modernization initiatives.
• Experience with engaging with the Medicaid Provider Community.
• Familiarity with CMS MITA framework and APD/CPR processes.
• Familiarity with Gainwell’s MMIS system.
Benefit packages for this role will start on the 1st day of employment and include medical, dental, and vision insurance, as well as HSA, FSA, and DCFSA account options, and 401k retirement account access with employer matching. Employees in this role are also entitled to paid sick leave and/or other paid time off as provided by applicable law.