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Posted 5 months ago
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Requirements and responsibilities
Position Summary:The Formulary Operations Manager is responsible for providing operational support for the evaluation, implementation, and maintenance of our standard and custom Commercial and Exchange formularies and utilization management. This individual supports the creation and maintenance of formulary, clinical adjudication list, and utilization management lists, preparation of Exchange JSON formulary submission files and member formulary drug lists, preparation and review of updates for implementation, and other formulary and utilization management related tasks and processes. The role requires strong cross functional collaboration and communication skills, and an understanding of formulary operations processes.Position Responsibilities:Define, configure, and maintain standard and custom formularies for the Commercial and Health Information Marketplace/Exchange lines of businessProvide client-facing strategic and operational support for the configuration, implementation, maintenance, and quality control of custom formularies, drug lists, custom formulary marketing materials, clinical adjudication lists, and utilization management editsEvaluate appropriateness and operationalize custom client formulary and benefit requests within the formulary/adjudication platformCollaborates with teams in a cross-functional environment including, but not limited to; benefit administration, rebate administration, client account management, analytics, software development/product, regulatory/compliance, government programs, member experience, prior authorization operations, and marketingDevelop weekly drug product review and formulary recommendations by assessing drug use trends, new drug releases, and review of primary literatureAnalyze pharmacy cost of care, clinical updates, and coordinate the development of appropriate formulary management programs and utilization management editsSet criteria for medication analysis and coordinate methodology for client requested and regulatory formulary reporting requirementsEvaluate drugs/drug classes and make formulary positioning and utilization management recommendations and formulary management strategies and associated adjudication requirements to operationalizeProvide cross functional support for claim troubleshooting within the adjudication platformSupport comprehensive testing of client formulary and benefit electionsSupport formulary change processes within URAC/NCQA/SOC guidelines and requirementsSupport client formulary requests, as requiredSupport quality improvement projects, as requiredSupport the company pharmaceutical pipeline, as neededSupport Request for Information (RFI) and Request for Proposal (RFP) submissions, as neededSupport general business needs and operations, as requiredResponsible for adherence to the company Code of Conduct including reporting of noncomplianceMinimum Qualifications:Doctor of Pharmacy (PharmD) Degree from an accredited institution, with record of strong academic performanceCurrent, unrestricted registered pharmacist license(s)Residency/fellowship preferred2-3 years of formulary experience working for a health plan or PBM preferred2-3 years of Medicare experience preferredKnowledge of formulary development and maintenance processesKnowledge of highly managed specialty medications/strategyKnowledge of rebate and financial implications of formulary strategiesExperience working with large datasets preferredAbility to independently identify, research, and resolve issuesAbility to balance multiple complex projects simultaneouslyAbility to work extended hours, weekends, and holidays consistent with industry demandsExceptional written and verbal communication skillsExtremely flexible, highly organized, and able to shift priorities easilyAttention to detail & commitment to delivering high quality work productMicrosoft office suite with emphasis on Microsoft excel proficiency required* This position is being recruited on behalf of a client in the Pharmacy Benefit Manager (PBM) industry. Company name disclosed upon advancing in the process.The pay range for this role is:135,000 - 145,000 USD per year (Remote)
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