Oscar Health
Manager, Formulary & Medical Pharmacy Operations
Oscar Health, Atlanta, Georgia, United States, 30383
Manager, Formulary & Medical Pharmacy Operations – Oscar Health
Hi, we’re Oscar. We’re hiring a Manager, Formulary & Medical Pharmacy Operations to join our Pharmacy team.
Oscar is the first health insurance company built around a full stack technology platform and a focus on serving our members. We started Oscar in 2012 to create the kind of health insurance company we would want for ourselves—one that behaves like a doctor in the family.
About the Role You will oversee and manage clinical pharmacy initiatives driving affordability savings, including core formulary management operations. You will partner across Pharmacy, Medical Economics, and the Office of Clinical Affairs to operationalize pharmacy-related workflows and monitor existing savings initiatives for drugs on both the pharmacy and medical benefits.
You will report to the Senior Manager, Formulary Operations and Pharmacy Utilization Management.
Work Location This is a remote position, open to candidates who reside in Atlanta, GA. You will be fully remote; however, our approach to work may adapt over time. Future models could potentially involve a hybrid presence at the hub office associated with your metro area.
Pay Transparency The base pay for this role is: $144,000 - $189,000 per year. Eligible for employee benefits, participation in Oscar's unlimited vacation program and annual performance bonuses.
Responsibilities
Provide insights and recommendations for trend management and clinical effectiveness, including serving as a key contributor in the enterprise affordability process for pharmacy.
Manage the pipeline of enterprise affordability projects across the pharmacy department (program operations and clinical) and oversee the performance of active initiatives.
Partner with leads across the organization as necessary to communicate, understand and identify upstream and downstream impacts to the business.
Contribute to the design and implementation of clinical programs focused on improving patient outcomes and reducing costs.
Develop and maintain a clinically appropriate and cost-effective formulary by operating and managing Oscar’s P&T committee, evaluating new developments in the drug treatment landscape, and providing recommendations on managing new-to-market drugs and new drug indications.
Oversee and optimize medical pharmacy preferred drug lists and strategies to support utilization of lowest unit cost infusion products.
Provide written recommendations and documentation for regulatory inquiries, future legislation feedback, and other business questions related to formulary operations.
Maintain mental health parity NQTL responses, work cross-functionally for future filings and respond to ongoing objections during audit processes.
Ensure compliance with all applicable laws and regulations.
Other duties as assigned.
Qualifications
Doctor of Pharmacy degree (PharmD).
4+ years working for a PBM or payer in clinical pharmacy operations.
4+ years leading cross-functional teams/projects and change management.
3+ years supporting formulary management (P&T Committee, clinical policy development, formulary run operations).
Bonus points
Residency training.
Experience with marketplace exchange and Medicare advantage.
Equal Opportunity Employer At Oscar, being an Equal Opportunity Employer means more than upholding discrimination-free hiring practices. It means that we cultivate an environment where people can be their most authentic selves and find both belonging and support. We’re on a mission to change health care — an experience made whole by our unique backgrounds and perspectives.
Artificial Intelligence (AI) Our AI Guidelines outline the acceptable use of artificial intelligence for candidates and detail how we use AI to support our recruiting efforts.
Reasonable Accommodation Oscar applicants are considered solely based on their qualifications, without regard to applicant’s disability or need for accommodation. Any applicant who requires reasonable accommodations should contact the Oscar Benefits Team at accommodations@hioscar.com.
California Residents For information about our collection, use, and disclosure of applicants’ personal information as well as applicants’ rights over their personal information, please see our Notice to Job Applicants.
#J-18808-Ljbffr
Oscar is the first health insurance company built around a full stack technology platform and a focus on serving our members. We started Oscar in 2012 to create the kind of health insurance company we would want for ourselves—one that behaves like a doctor in the family.
About the Role You will oversee and manage clinical pharmacy initiatives driving affordability savings, including core formulary management operations. You will partner across Pharmacy, Medical Economics, and the Office of Clinical Affairs to operationalize pharmacy-related workflows and monitor existing savings initiatives for drugs on both the pharmacy and medical benefits.
You will report to the Senior Manager, Formulary Operations and Pharmacy Utilization Management.
Work Location This is a remote position, open to candidates who reside in Atlanta, GA. You will be fully remote; however, our approach to work may adapt over time. Future models could potentially involve a hybrid presence at the hub office associated with your metro area.
Pay Transparency The base pay for this role is: $144,000 - $189,000 per year. Eligible for employee benefits, participation in Oscar's unlimited vacation program and annual performance bonuses.
Responsibilities
Provide insights and recommendations for trend management and clinical effectiveness, including serving as a key contributor in the enterprise affordability process for pharmacy.
Manage the pipeline of enterprise affordability projects across the pharmacy department (program operations and clinical) and oversee the performance of active initiatives.
Partner with leads across the organization as necessary to communicate, understand and identify upstream and downstream impacts to the business.
Contribute to the design and implementation of clinical programs focused on improving patient outcomes and reducing costs.
Develop and maintain a clinically appropriate and cost-effective formulary by operating and managing Oscar’s P&T committee, evaluating new developments in the drug treatment landscape, and providing recommendations on managing new-to-market drugs and new drug indications.
Oversee and optimize medical pharmacy preferred drug lists and strategies to support utilization of lowest unit cost infusion products.
Provide written recommendations and documentation for regulatory inquiries, future legislation feedback, and other business questions related to formulary operations.
Maintain mental health parity NQTL responses, work cross-functionally for future filings and respond to ongoing objections during audit processes.
Ensure compliance with all applicable laws and regulations.
Other duties as assigned.
Qualifications
Doctor of Pharmacy degree (PharmD).
4+ years working for a PBM or payer in clinical pharmacy operations.
4+ years leading cross-functional teams/projects and change management.
3+ years supporting formulary management (P&T Committee, clinical policy development, formulary run operations).
Bonus points
Residency training.
Experience with marketplace exchange and Medicare advantage.
Equal Opportunity Employer At Oscar, being an Equal Opportunity Employer means more than upholding discrimination-free hiring practices. It means that we cultivate an environment where people can be their most authentic selves and find both belonging and support. We’re on a mission to change health care — an experience made whole by our unique backgrounds and perspectives.
Artificial Intelligence (AI) Our AI Guidelines outline the acceptable use of artificial intelligence for candidates and detail how we use AI to support our recruiting efforts.
Reasonable Accommodation Oscar applicants are considered solely based on their qualifications, without regard to applicant’s disability or need for accommodation. Any applicant who requires reasonable accommodations should contact the Oscar Benefits Team at accommodations@hioscar.com.
California Residents For information about our collection, use, and disclosure of applicants’ personal information as well as applicants’ rights over their personal information, please see our Notice to Job Applicants.
#J-18808-Ljbffr