Clinical Consulting Solutions
Formulary Operations Manager
Clinical Consulting Solutions, Lisbon Falls, Maine, United States
UNITAS provides clinical staffing and consulting solutions, including contract staff augmentation, permanent talent recruiting, consulting, and clinical coaching. Our extensive experience includes Pharmacy Benefit Management, Long-Term Care, Retail Pharmacy, Hospital, and Leadership, enabling us to connect the best clinical talent with outstanding companies. We know clinicians because we are clinicians!
Position Summary The Formulary OperationsManageris responsible forproviding operational support for the evaluation, implementation, and maintenance ofour standard and custom Commercial and Exchangeformularies andutilizationmanagement. This individual supportsthecreation and maintenance of formulary, clinical adjudication list,andutilizationmanagement lists, preparation ofExchange JSONformularysubmissionfiles and member formulary drug lists,preparationand review of updates for implementation, and other formulary andutilizationmanagement related tasks and processes. The role requires strong cross functional collaboration and communication skills, and an understanding offormularyoperationsprocesses.
Position Responsibilities Define, configure, and maintain standard and custom formularies for the Commercial and Health Information Marketplace/Exchange lines of business Provide client-facing strategic and operational support for the configuration, implementation, maintenance, and quality control of custom formularies, drug lists, custom formularies marketing materials, clinical adjudication lists, and utilization management edits Evaluate appropriateness and operationalize custom client formulary and benefit requests within the formulary/adjudication platform Collaborates 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 marketing Develop weekly drug product review and formulary recommendations by assessing drug use trends, new drug releases, and review of primary literature Analyze pharmacy cost of care, clinical updates, and coordinate the development of appropriate formulary management programs and utilization management edits Set criteria for medication analysis and coordinate methodology for client requested and regulatory formulary reporting requirements Evaluate drugs/drug classes and make formulary positioning and utilization management recommendations and formulary management strategies and associated adjudication requirements to operationalize Provide cross functional support for claim troubleshooting within the adjudication platform Support comprehensive testing of client formulary and benefit elections Support formulary change processes within URAC/NCQA/SOC guidelines and requirements Support client formulary requests, as required Support quality improvement projects, as required Support the company pharmaceutical pipeline, as needed Support Request for Information (RFI) and Request for Proposal (RFP) submissions, as needed Support general business needs and operations, as required Responsible for adherence to the company Code of Conduct including reporting of noncompliance
MinimumQualifications Doctor of Pharmacy (PharmD) Degree from an accredited institution, with record of strong academic performance Current, unrestricted registered pharmacist license(s) 2-3 years of formulary experience working for a health plan or PBM preferred 2-3 years of Medicare experience preferred Knowledge of formulary development and maintenance processes Knowledge of highly managed specialty medications/strategy Knowledge of rebate and financial implications of formulary strategies Experience working with large datasets preferred Ability to independently identify, research, and resolve issues Ability to balance multiple complex projects simultaneously Ability to work extended hours, weekends, and holidays consistent with industry demands Exceptional written and verbal communication skills Extremely flexible, highly organized, and able to shift priorities easily Attention to detail & commitment to delivering high quality work product Microsoft 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.
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Position Summary The Formulary OperationsManageris responsible forproviding operational support for the evaluation, implementation, and maintenance ofour standard and custom Commercial and Exchangeformularies andutilizationmanagement. This individual supportsthecreation and maintenance of formulary, clinical adjudication list,andutilizationmanagement lists, preparation ofExchange JSONformularysubmissionfiles and member formulary drug lists,preparationand review of updates for implementation, and other formulary andutilizationmanagement related tasks and processes. The role requires strong cross functional collaboration and communication skills, and an understanding offormularyoperationsprocesses.
Position Responsibilities Define, configure, and maintain standard and custom formularies for the Commercial and Health Information Marketplace/Exchange lines of business Provide client-facing strategic and operational support for the configuration, implementation, maintenance, and quality control of custom formularies, drug lists, custom formularies marketing materials, clinical adjudication lists, and utilization management edits Evaluate appropriateness and operationalize custom client formulary and benefit requests within the formulary/adjudication platform Collaborates 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 marketing Develop weekly drug product review and formulary recommendations by assessing drug use trends, new drug releases, and review of primary literature Analyze pharmacy cost of care, clinical updates, and coordinate the development of appropriate formulary management programs and utilization management edits Set criteria for medication analysis and coordinate methodology for client requested and regulatory formulary reporting requirements Evaluate drugs/drug classes and make formulary positioning and utilization management recommendations and formulary management strategies and associated adjudication requirements to operationalize Provide cross functional support for claim troubleshooting within the adjudication platform Support comprehensive testing of client formulary and benefit elections Support formulary change processes within URAC/NCQA/SOC guidelines and requirements Support client formulary requests, as required Support quality improvement projects, as required Support the company pharmaceutical pipeline, as needed Support Request for Information (RFI) and Request for Proposal (RFP) submissions, as needed Support general business needs and operations, as required Responsible for adherence to the company Code of Conduct including reporting of noncompliance
MinimumQualifications Doctor of Pharmacy (PharmD) Degree from an accredited institution, with record of strong academic performance Current, unrestricted registered pharmacist license(s) 2-3 years of formulary experience working for a health plan or PBM preferred 2-3 years of Medicare experience preferred Knowledge of formulary development and maintenance processes Knowledge of highly managed specialty medications/strategy Knowledge of rebate and financial implications of formulary strategies Experience working with large datasets preferred Ability to independently identify, research, and resolve issues Ability to balance multiple complex projects simultaneously Ability to work extended hours, weekends, and holidays consistent with industry demands Exceptional written and verbal communication skills Extremely flexible, highly organized, and able to shift priorities easily Attention to detail & commitment to delivering high quality work product Microsoft 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.
#J-18808-Ljbffr