Job Description

Department

Department of Business Regulation

Division

Project/Program Management

Salary

$125,132.00 - $144,254.00

Job Profile

JC-00520900-99 - Director of Intergovernmental Relations (Non-Union Executive Branch)

Scheduled Work Days & Work Hours

Monday - Friday, 8:00 am - 4:00 pm

Non-Standard

Job Requisition Number

JR103785 DIRECTOR OF INTERGOVERNMENTAL RELATIONS (Open)

Pay Grade

U00840 A

Classification

Director of Intergovernmental Relations

Class Definition

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.

Core responsibilities include: (a) administering the PBM certification program and related regulatory requirements; (b) monitoring and evaluating PBM compliance through compliance investigations, market conduct examinations, reporting requirements, and enforcement activities; (c) developing regulations, guidance documents, and policies necessary to implement Rhode Island law; (d) collaborating with insurers, pharmacies, providers, state agencies, and other stakeholders to support effective program administration; and (e) advising the Commissioner on matters relating to pharmacy benefit manager regulation, prescription drug policy, and legislative initiatives.

ILLUSTRATIVE EXAMPLES OF WORK PERFORMED

1. 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.

2. Monitor Compliance and Conduct Regulatory Oversight.
• 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.

3. Develop Regulatory Policy and Guidance.
• 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.

4. Coordinate Stakeholder Engagement.
• 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.

5. Manage Program Operations and Reporting.
• 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.

SUPPLEMENTAL INFORMATION

• Knowledge of regulatory compliance, administrative law, investigations, and enforcement.

• Knowledge of health insurance regulation, pharmacy benefit management, prescription drug benefit administration, and applicable laws preferred.
• Ability to interpret complex statutes, regulations, and contracts.
• Experience developing policies, regulations, or legislative recommendations preferred.
• 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.

MINIMUM QUALIFICATIONS

Graduation from a college of recognized standing with a bachelor's degree. 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.

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.

While candidates with a law degree are preferred, any combination of education and experience substantially equivalent to the above qualifications will be considered.

Supplemental Information

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/

Also, be advised that a new provision in RI General Law 35-6-1 was enacted requiring direct deposit for all employees. Specific to new hires, the law requires that all employees hired after September 30, 2014 participate in direct deposit. Accordingly, any employee hired after this date will be required to participate in the direct deposit system. At the time the employee is hired, the employee shall identify a financial institution that will serve as a personal depository agency for the employee.