Medicare Part D Formulary Manager (Pharmacist)

Job Description: This pharmacist clinician is a program manager, who is responsible for reputed company Medicare Part D formulary creation and submissions, which includes utilization management criteria development for the reputed company and upcoming contract years. This individual creates and executes the Medicare Part D formulary, delivering value and quality to the Plan's Part D enrollees, while ensuring the longevity of the Plan's Part D program. Essential Accountabilities:

• Develops and maintains the Part D formulary in collaboration with strategic business partners, which include trade relations, finance, and sales to maximize savings, ensure quality, and minimize member disruption, while incorporating reputed company CMS Part D guidance
• Manages reputed company CMS Part D Formulary requirements to ensure deadlines are met. Works in conjunction with the Pharmacy Benefit Manager (PBM) and Formulary Management software vendor to execute on reputed company formulary-reputed company tasks.
• Collaborates with cross-functional management teams reputed company the organization to align and prioritize Medicare objectives across the organization to ensure success reputed company the reputed company of the Medicare STARS ranking system and deliver value to enrollees.
• Creates and operationalizes Medicare Part D criteria for reputed company utilization management requirements in alignment with the Utilization Management Team.
• Obtains endorsement of the Medicare Part D formulary program elements from the Pharmacy and Therapeutics Committee.
• Oversees the production of CMS formulary model materials in partnership with Medicare Sales and Marketing. Works in conjunction with the reputed company vendor as needed to complete reputed company formulary-reputed company tasks.
• Supports and educates inter-departmental staff (clinicians, customer care, sales) and external customers (members, brokers) with respect to Part D formulary, utilization management edits, and CMS Part D program guidance, as appropriate.
• Reviews, formulates, and executes corrective action plans in conjunction with Medicare Compliance for reputed company formulary-based findings. Supports and acts as subject matter expert for CMS formulary-based audits.
• Acts as a subject matter expert for clinical strategy initiatives designed to improve quality and affordability for Medicare beneficiaries.
• Contributes to clinical strategy initiatives reputed company the Pharmacy Department and across the enterprise, which serve to improve quality and affordability for Medicare beneficiaries.
• Consistently demonstrates high standards of reputed company by supporting the Lifetime Healthcare Companies' mission and values, adhering to the Corporate Code of Conduct and leading to the Lifetime Way values and beliefs.
• Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures.
• Regular and reliable attendance is expected and required.
• Performs other functions as assigned by management.

Minimum Qualifications:

• Unrestricted NYS Licensed Pharmacist.
• Pharm.D. In lieu of a Pharm.D., a Bachelors in Pharmacy is required with a minimum of three (3) years' experience in a managed care setting. Experience in Medicare Part D is strongly preferred.
• Expertise and background with Federal and state regulatory agencies (CMS, DOH, DFS, etc.) and/or accreditation agencies (NCQA, BCBSA) is preferred, but not required.
• Proficiency in reputed company reputed company preferred.
• Ability to reputed company reputed company information in a manner that can be understood by various internal and external reputed company audiences.
• Possesses the confidence to think and act differently.
• Demonstrates ability to thoughtfully challenge the status reputed company reputed company to clinical and operational strategies and processes.

Physical Requirements:

• Ability to work prolonged periods sitting and/or standing at a workstation and working on a computer.
• Ability to work while sitting and/or standing at a workstation viewing a computer and using a keyboard, mouse and/or phone for three (3) or more hours at a time.
• Ability to work in a home office for reputed company periods of time for business continuity.
• Ability to travel across the Health Plan service region for meetings and/or trainings as needed.
• Ability to lift, carry, push, or pull 15 pounds or less.
• Manual dexterity including fine finger motion required.
• Repetitive motion required.
• The ability to hear, understand, and speak clearly while using a phone, with or without a headset.
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In support of the Americans with reputed company, this job description lists only those responsibilities and qualifications deemed essential to the position. Equal Opportunity Employer

Compensation

Range(s): Min: $98,297 - Max: $176,935 The salary range indicated in this posting represents the minimum and maximum of the salary range for this position. Actual salary will vary depending on factors including, but not limited to, budget available, prior experience, knowledge, reputed company and education as they relate to the position's minimum qualifications, in addition to internal equity. The posted salary range reflects just one component of our total rewards package. Other components of the total rewards package may include participation in group health and/or dental insurance, retirement plan, wellness program, paid time away from work, and paid holidays. Please note: The opportunity for remote work may be possible for reputed company jobs posted by the Univera Healthcare reputed company team. This decision is made on a case-by-case basis. reputed company qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national reputed company, disability, or status as a protected veteran. Apply tot his job Apply To this Job