SCAN
Clinical Formulary Pharmacist
at
SCAN
– a not‑for‑profit organization dedicated to improving the health of older adults in the United States.
SCAN Group is the sole corporate member of SCAN Health Plan, one of the nation’s leading not‑for‑profit Medicare Advantage plans, serving more than 277,000 members across California, Arizona, Nevada, Texas and New Mexico. The organization has a mission of keeping seniors healthy and independent for over 45 years.
Job Description The Clinical Formulary Pharmacist will provide operational support for the evaluation, implementation, and maintenance of Medicare Part D formulary and utilization management activities. The role is responsible for ensuring regulatory compliance, managing formulary submissions to CMS, coordinating with PBM, and overseeing various website, training and member communication initiatives.
Key responsibilities include:
Ensuring regulatory compliance with P&T operations, formulary & benefit administration, transition programs, Part D bid submissions, and CMS regulatory audits.
Producing, maintaining, and implementing Part D formulary, prior authorization criteria, step therapy criteria, supplemental files, and clinical rules in accordance with CMS requirements on a monthly and annual basis.
Developing and maintaining formulary exception criteria.
Evaluating and reviewing new drugs/biosimilars with the Pharmacy & Therapeutics Subcommittee/Committee within 90–180 days of marketing and making formulary and UM recommendations based on clinical appropriateness, cost analysis and CMS guidelines.
Co‑working with Medical Directors to evaluate treatment protocols and procedures related to the SCAN Health Plan formulary at least annually.
Providing CMS Part D regulatory audit support.
Producing member communications and marketing materials within internal time‑frames and in accordance with CMS marketing guidelines, in partnership with Marketing, Compliance, and Member Services.
Maintaining an online comprehensive formulary on a monthly basis in compliance with CMS requirements.
Assisting with formulary and UM modeling for the annual Formulary and BID submissions to CMS.
Preparing annual formulary/pharmacy benefits industry analysis and implementing Inflation Reduction Act requirements with PBM and CMS Innovation Programs.
Monitoring drug pipeline, trends and payer changes to identify high Part D impact drugs and manage Part B drug trend opportunities.
Overseeing PBM operations in the areas of formulary, opioid safety edits, pharmacy benefits, transition programs, prescriber enrollment and pharmacy network implementation.
Ensuring AEP and 1/1 readiness and assisting in training other departments.
Maintaining current knowledge of Medicare Part D regulations through CMS calls, guidance reviews and regulatory changes.
Managing multiple deadlines and completing projects with 100 % accuracy.
Maintaining professional and technical knowledge through research, educational and technological workshops.
Collaborating with Pharmacy Department staff and other SCAN departments (Compliance, Marketing, HCI, Product, Member Services) to support SCAN’s vision and goals.
Seeking opportunities to apply AI innovations to improve operations and member services.
Actively supporting SCAN’s vision and goals.
Other duties as assigned.
Your Qualifications
3–5 years of related experience.
Bachelor’s degree required; Pharm D preferred.
Pharmacist (PH) certification.
Registered pharmacy licensure required within 6 months of hire.
Residency program in managed care, pharmacy practice, drug information or geriatric pharmacy preferred.
Managed care experience at PBM, health plan or medical group required.
Medicare Part D formulary management experience required.
Excellent verbal/written communication, interpersonal, presentation, customer service, problem‑solving and computer skills required.
Effective utilization of information systems required.
Technical skills: Microsoft Office (Word, Excel, PowerPoint, Outlook, Teams) required; SQL, Tableau, and/or Alteryx preferred.
What's in it for you?
Base salary range: $125,400 to $181,419 per year.
Internal title: Clinical Pharmacist.
Work mode: Hybrid (twice a week in office required).
An annual employee bonus program.
Robust wellness program.
Generous paid time‑off (PTO).
11 paid holidays per year, plus 1 floating holiday, plus 1 birthday holiday.
Excellent 401(k) retirement saving plan with employer match and contribution.
Robust employee recognition program.
Tuition reimbursement.
An opportunity to make a difference to our members and community every day!
We are always looking for talented people to join our team. Qualified applicants are encouraged to apply now.
Equal Opportunity Employer/Protected Veterans/Individuals With Disabilities
At SCAN we believe it is our business to improve the state of our world. We are committed to driving equality in our communities and workplaces. We provide an inclusive workforce through equal pay, employee resource groups, inclusive benefits and more.
SCAN is proud to be an Equal Employment Opportunity and affirmative action workplace. Individuals seeking employment will receive consideration without regard to race, color, national origin, religion, age, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender perception or identity, disability, protected veteran status or any other status protected by law. A background check is required.
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at
SCAN
– a not‑for‑profit organization dedicated to improving the health of older adults in the United States.
SCAN Group is the sole corporate member of SCAN Health Plan, one of the nation’s leading not‑for‑profit Medicare Advantage plans, serving more than 277,000 members across California, Arizona, Nevada, Texas and New Mexico. The organization has a mission of keeping seniors healthy and independent for over 45 years.
Job Description The Clinical Formulary Pharmacist will provide operational support for the evaluation, implementation, and maintenance of Medicare Part D formulary and utilization management activities. The role is responsible for ensuring regulatory compliance, managing formulary submissions to CMS, coordinating with PBM, and overseeing various website, training and member communication initiatives.
Key responsibilities include:
Ensuring regulatory compliance with P&T operations, formulary & benefit administration, transition programs, Part D bid submissions, and CMS regulatory audits.
Producing, maintaining, and implementing Part D formulary, prior authorization criteria, step therapy criteria, supplemental files, and clinical rules in accordance with CMS requirements on a monthly and annual basis.
Developing and maintaining formulary exception criteria.
Evaluating and reviewing new drugs/biosimilars with the Pharmacy & Therapeutics Subcommittee/Committee within 90–180 days of marketing and making formulary and UM recommendations based on clinical appropriateness, cost analysis and CMS guidelines.
Co‑working with Medical Directors to evaluate treatment protocols and procedures related to the SCAN Health Plan formulary at least annually.
Providing CMS Part D regulatory audit support.
Producing member communications and marketing materials within internal time‑frames and in accordance with CMS marketing guidelines, in partnership with Marketing, Compliance, and Member Services.
Maintaining an online comprehensive formulary on a monthly basis in compliance with CMS requirements.
Assisting with formulary and UM modeling for the annual Formulary and BID submissions to CMS.
Preparing annual formulary/pharmacy benefits industry analysis and implementing Inflation Reduction Act requirements with PBM and CMS Innovation Programs.
Monitoring drug pipeline, trends and payer changes to identify high Part D impact drugs and manage Part B drug trend opportunities.
Overseeing PBM operations in the areas of formulary, opioid safety edits, pharmacy benefits, transition programs, prescriber enrollment and pharmacy network implementation.
Ensuring AEP and 1/1 readiness and assisting in training other departments.
Maintaining current knowledge of Medicare Part D regulations through CMS calls, guidance reviews and regulatory changes.
Managing multiple deadlines and completing projects with 100 % accuracy.
Maintaining professional and technical knowledge through research, educational and technological workshops.
Collaborating with Pharmacy Department staff and other SCAN departments (Compliance, Marketing, HCI, Product, Member Services) to support SCAN’s vision and goals.
Seeking opportunities to apply AI innovations to improve operations and member services.
Actively supporting SCAN’s vision and goals.
Other duties as assigned.
Your Qualifications
3–5 years of related experience.
Bachelor’s degree required; Pharm D preferred.
Pharmacist (PH) certification.
Registered pharmacy licensure required within 6 months of hire.
Residency program in managed care, pharmacy practice, drug information or geriatric pharmacy preferred.
Managed care experience at PBM, health plan or medical group required.
Medicare Part D formulary management experience required.
Excellent verbal/written communication, interpersonal, presentation, customer service, problem‑solving and computer skills required.
Effective utilization of information systems required.
Technical skills: Microsoft Office (Word, Excel, PowerPoint, Outlook, Teams) required; SQL, Tableau, and/or Alteryx preferred.
What's in it for you?
Base salary range: $125,400 to $181,419 per year.
Internal title: Clinical Pharmacist.
Work mode: Hybrid (twice a week in office required).
An annual employee bonus program.
Robust wellness program.
Generous paid time‑off (PTO).
11 paid holidays per year, plus 1 floating holiday, plus 1 birthday holiday.
Excellent 401(k) retirement saving plan with employer match and contribution.
Robust employee recognition program.
Tuition reimbursement.
An opportunity to make a difference to our members and community every day!
We are always looking for talented people to join our team. Qualified applicants are encouraged to apply now.
Equal Opportunity Employer/Protected Veterans/Individuals With Disabilities
At SCAN we believe it is our business to improve the state of our world. We are committed to driving equality in our communities and workplaces. We provide an inclusive workforce through equal pay, employee resource groups, inclusive benefits and more.
SCAN is proud to be an Equal Employment Opportunity and affirmative action workplace. Individuals seeking employment will receive consideration without regard to race, color, national origin, religion, age, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender perception or identity, disability, protected veteran status or any other status protected by law. A background check is required.
#J-18808-Ljbffr