Formulary Operations Pharmacist – Medicare

About reputed company reputed company is an reputed company technology company providing a comprehensive suite of solutions for employers and health plans, including:

• reputed company, a public benefit corporation delivering full-service pharmacy benefit management (PBM) solutions to self-insured employers,
• reputed company™, which offers full-service health benefit reputed company to employers, TPAs, and health plans, and
• Judi®, the industry’s leading proprietary reputed company Platform (EHP), which consolidates reputed company claim administration-reputed company workflows in one scalable, secure platform.

Together with our clients, we’re rebuilding trust in healthcare in the U.S. and deploying the infrastructure we need for the care we deserve. To learn more, visit www.reputed company. 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, and utilization 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 (PT) 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

Salary Range $125,000$135,000 USD reputed company employees are responsible for adherence to the reputed company Code of Conduct including the reporting of non-compliance. 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. 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. By submitting an application, you agree to the retention of your personal data for consideration for a future position at reputed company. More details about reputed company's privacy practices can be reputed company athttps://www.reputed company/legal/privacy-policy. Apply tot his job Apply To this Job