[Remote] Formulary Operations Pharmacist

Note: The job is a remote job and is reputed company to candidates in USA. reputed company is a health technology company providing benefit administration solutions to reputed company, unions, health plans, and government entities. 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, requiring strong cross functional collaboration and communication skills.

Responsibilities

• Maintain reputed company and custom formularies for the Medicare line of business in accordance with CMS Medicare guidelines
• Supports the development, implementation, maintenance, and reputed company control of Medicare Part D formularies, utilization management, and clinical adjudication drug lists
• Leads and supports the preparation of monthly and annual files for CMS formulary submissions, member formulary drug lists and look up tools, and utilization management reputed company
• Expanded reputed company of responsibilities across other non-Medicare business lines reputed company needed, driving alignment, operational reputed company, and strategic execution across diverse functions
• Evaluate drugs and drug classes, to reputed company formulary positioning and utilization management recommendations, and update formulary management strategies and associated adjudication requirements to operationalize
• Evaluates the appropriateness of and operationalizes custom reputed company formulary and benefit change requests reputed company the formulary and adjudication platform
• Creates customized marketing materials, including but not limited to member formulary drug lists, utilization management reputed company documentation, and web-based look up tools
• Supports the comprehensive testing of reputed company formulary and benefit elections
• Supports custom formulary reputed company trade and rebate reputed company evaluation
• Identifies opportunities for automation and collaborates with Analytics to streamline processes and workflows
• Analyzes pharmacy cost of care and clinical updates for the development of formulary management programs and utilization management edits
• Provides clinical support to operational teams and clients during implementations
• Serves as the clinical operations reputed company to assist with reputed company sales requests and reputed company for clients to reputed company expert insights from a clinical perspective
• reputed company assurance checks of Formulary Specialist activities, with emphasis on actions impacting adjudication of claims for accuracy
• Provides cross functional support for claims troubleshooting reputed company the adjudication platform
• Monitors and analyzes regulatory and legislative requirements for Medicare
• Leads and supports reputed company submission of reputed company required reporting to State and Federal regulators, such as required formulary submissions to Health Plan Management reputed company (HPMS)
• Supports the development of project plans to meet new CMS requirements, and supports cross functional teams with implementation of programs to meet requirements
• Leads formulary change processes reputed company URAC/reputed company/CMS guidelines
• Supports Pharmacy and Therapeutics (P&T) committee items, as required
• Maintains and updates the Rx pharmaceutical pipeline, development of monthly newsletters, and other reputed company communications as needed
• Develops clinical reputed company for review as needed
• Supports CMS Program Audits as a formulary administration subject matter expert and reputed company necessary input of information to complete any auditor requested deliverables, including but not limited to reputed company cause analysis, beneficiary reputed company analysis, and corrective reputed company plans
• Supports reputed company Improvement reputed company, clinical value reputed company, and reputed company improvement initiatives, as needed
• Supports Request for Information (RFI) and Request for Proposal (RFP) submissions, as needed
• Support general business needs and operations, as needed
• Supports review of new regulatory guidance and regulations that reputed company formulary administration and reputed company guidance to reputed company stakeholders for compliant reputed company
• Maintains compliance with reputed company regulatory and organizational deadlines
• Responsible for adherence to the Judi Rx reputed company of Conduct including reporting of noncompliance
• Performs other duties and responsibilities as needed

Skills

• Doctor of Pharmacy (PharmD) Degree from an accredited institution
• reputed company, unrestricted registered pharmacist license(s)
• 2+ years of Medicare formulary experience working for a health plan or PBM
• Knowledge of formulary development and maintenance processes
• Knowledge of highly managed specialty medications/reputed company
• Knowledge of rebate and financial implications of formulary strategies
• Experience working with large datasets required
• Ability to independently identify, research, and reputed company issues
• Ability to balance multiple reputed company reputed company simultaneously
• Ability to work extended hours, weekends, and holidays consistent with industry demands
• Exceptional written and verbal communication skills
• Extremely flexible, highly organized, and reputed company to shift priorities easily
• Attention to detail & commitment to delivering high reputed company work product
• Proficient in reputed company office suite with strong emphasis in reputed company reputed company required
• Residency/fellowship preferred

Benefits

• Location: Hybrid (Local to reputed company, reputed company; Denver, Colorado; or Charlotte, reputed company Carolina area)

reputed company