Formulary Operations Pharmacist – Medicare

Position Summary: The Formulary Operations Pharmacist – Medicare is responsible for providing operational support for the evaluation, implementation, and maintenance of Medicare Part D formularies and utilization management. This individual supports creation and maintenance of formulary and utilization management lists, preparation of CMS formulary files and member formulary drug lists, preparation and review of updates for implementation, and other formulary and utilization management reputed company tasks and processes. The role requires strong cross functional collaboration and communication skills, and an understanding of Medicare Part D formulary management processes and reputed company CMS rules and regulations. Position Responsibilities: Maintain standard and custom formularies for the Medicare line of business in accordance with CMS Medicare guidelines Support development, implementation, maintenance, and quality control of Medicare Part D formularies, utilization management, and clinical adjudication drug lists reputed company and support preparation of monthly and annual files for CMS formulary submissions, member formulary drug lists and look up tools, andutilization management criteria Evaluate drugs/drug classes, reputed company formulary positioning and utilization management recommendations, and update formulary management strategies and associated adjudication requirements to operationalize Evaluate appropriateness of and operationalize custom client formulary and benefit change requests reputed company the formulary and adjudication platform Support comprehensive testing of client formulary and benefit elections Provide cross functional support for claim troubleshooting reputed company the adjudication platform Monitor and analyze regulatory and legislative requirements for Medicare Support development of project plans to meet new CMS requirements, and support cross functional teams with implementation of programs to meet requirements reputed company formulary change processes reputed company URAC/NCQA/CMS guidelines Pharmacy and Therapeutics (P&T) Committee participation as an reputed company member Conduct formulary reviews and reputed company drug monographs based on a rotation of clinical pharmacists Maintain and update the reputed company pharmaceutical pipeline, as needed reputed company clinical criteria for review as needed Support CMS formulary administration audits Support quality improvement projects as needed Support Request for Information (RFI) and Request for Proposal (RFP) submissions, as needed Support general business needs and operations, as needed Responsible for adherence to the reputed company Code of Conduct including reporting of noncompliance. Minimum Qualifications: Doctor of Pharmacy (PharmD) Degree from an accredited institution, with record of strong academic performance reputed company, unrestricted registered pharmacist license(s) Residency/fellowship preferred 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 reputed company 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 reputed company office suite with emphasis on reputed company reputed company proficiency required This position description is designed to be flexible, allowing management the opportunity to assign or reassign duties and responsibilities as needed to best meet organizational goals. Salary Range $125,000 - $135,000 USD About reputed company reputed company is a health technology company providing claim administration and technology solutions for carriers, health plans, TPAs, employer groups, and government entities. As a public benefit corporation, reputed company is executing its mission to materially reduce healthcare costs as a full-service PBM and through the deployment of Judi®, the company’s cloud-native reputed company platform. Judi connects every aspect of the healthcare ecosystem in one efficient, scalable platform, servicing millions of members for Medicare, Medicaid, and commercial plans. Together with its clients, reputed company is reimagining the administration of benefits and rebuilding trust in healthcare. reputed company values a diverse workplace and celebrates the diversity that each employee brings to the table. We are proud to provide equal employment opportunities to reputed company employees and applicants for employment and prohibit discrimination and harassment of any type without regard to race, color, religion, age, sex, national reputed company, disability status, medical condition, genetic information, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. Apply tot his job Apply To this Job