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Formulary Administration Pharmacist
$104,342 - $146,600 - $188,858
“Pay scale information is not necessarily reflective of actual compensation that may be earned, nor a promise of any specific pay for any selected candidate or employee, which is always dependent on actual experience, education, qualifications, and other factors. A full review of our comprehensive pay and benefits will be discussed at the offer stage with the selected candidate.”
MedImpact Healthcare Systems, Inc. is looking for extraordinary people to join our team!
Why join MedImpact? Because our success is dependent on you; innovative professionals with top notch skills who thrive on opportunity, high performance, and teamwork. We look for individuals who want to work on a team that cares about making a difference in the value of healthcare.
At MedImpact, we deliver leading edge pharmaceutical and technology related solutions that dramatically improve the value of health care. We provide superior outcomes to those we serve through innovative products, systems, and services that provide transparency and promote choice in decision making. Our vision is to set the standard in providing solutions that optimize satisfaction, service, cost, and quality in the healthcare industry. We are the premier Pharmacy Benefits Management solution!
The Scoop:
The Formulary Administration Pharmacist manages operational aspects of business unit, department; acts as the subject matter expert (SME) to lead and support the execution of strategic initiatives, projects, and/or programs under guidance of Director and/or Manager, Formulary Administration & Strategy. This position focuses on efforts of the MedImpact Formulary Administration & Strategy Team in quality control and analysis of MedImpact client formulary set-up, rule sets, coding, accuracy, functionality, EOB, documentation, and concordance with client specified and regulatory requirements utilizing distinct but inter-related management and cross- departmental functions.
What You Get To Do:
- Maintains, facilitates access to, and distributes clinical formulary information, formulary product descriptions, recommendations for rational drug formulary positioning, application, and revision, when necessary, of standard utilization management, and recommendations regarding client pharmacy benefit expenditures and utilization
- Collaborates with Industry Relations for financial strategy, and Configuration Services for operational support
- Is knowledgeable of regulatory constraints on the pharmacy benefit and ensures compliance with Federal and State regulations for all line(s) of business (e.g., Medicare Part D, Medicaid, Commercial, and Health Insurance Exchange)
- Supports Medicare Part D formulary administration as follows:
- Promotes rational and appropriate drug use in the Medicare population
- Provides direct client clinical consultation relative to formulary drug placement, appropriate utilization management edits and related client specific documents for Step Therapy and Prior Authorization Guidelines required by CMS/States
- Provides direct client consultation on
- All formulary maintenance operations, programs, software, CMS/States statutory regulations, and CMS/States issued regulatory guidance to ensure continued CMS/States formulary approval
- All formulary maintenance operations, programs, software, CMS/States statutory regulations, and CMS/States issued regulatory guidance to ensure continued CMS/States formulary approval
- Coordinates quality control and analytics related to MedImpact Standard and Custom formulary changes including appropriate formulary content, application of utilization management activities, printed formularies, Plan Finder formulary files and other functions as required
- Ensures that the review, coding, and quality control of formulary changes occur in an appropriate, accurate, and timely manner based on client-specific parameters
- Ensures compliance with regulatory requirements for all formularies
- Supports Medicaid/Commercial/Health Insurance Exchange Formulary Administration as follows:
- Formulary creation and maintenance, utilization management creation and maintenance
- Collaborates with GPS, Compliance, and other departments to ensure generation of regulatory compliance, reporting, and submission files
- Collaborates with Industry Relations to provide clinical oversight and ensure financial strategy is properly operationalized
- Participates in meetings as necessary
- Support client teams with custom client formulary strategy recommendations
- Support of Formulary Decision Review meetings: attend meeting as clinical/operational support
- Develops formulary strategy and recommendations such as drug and UM positioning (quantity limits, step edit and prior authorization guidelines) in response to newly approved therapeutic agents, patent expirations, FDA alerts and drug recalls or withdrawals
- Researches and appropriately responds to formulary drug placement and UM rationale and coding questions
- Partners with other departments on a weekly, quarterly, and ad hoc basis on the Formulary decision process
- Contributes to internal and external client notifications of timely clinical issues through daily, monthly, and quarterly established communications
- Supports MedImpact Standard and Custom formulary print functions in accordance with CMS/States regulatory statute and guidance
- Reviews new drug categorization changes to customize, implement, and integrate with MedImpact printed formulary products as appropriate
- Provides formulary-specific documentation of maintenance activities to clients and regulatory bodies as appropriate
- Collaborates with Government Program Services (GPS) to provide Explanation of Benefits formulary changes to Medicare Part D formulary clients as appropriate
Supervisory Responsibilities
This job has no supervisory responsibilities.
Education and/or Experience
For consideration candidates will need:
- Doctor of Pharmacy (PharmD.) from an accredited school of pharmacy (or equivalent such as a Bachelors, Pharmacy and a RPh license) along with two (2) to five (5+) years’ related experience
- Prior PBM industry experience is preferred with specific experience in PBM/Benefits Services formulary setup/maintenance as well as experience with standardizing and streamlining work processes
Computer Skills
To perform this job successfully, an individual should have knowledge of Microsoft Office, Outlook, and a working knowledge of relational databases.
Certificates, Licenses, Registrations
Registered Pharmacist in the State of California or equivalent state.
Other Skills and Abilities
- Ability to learn cross functional operations within the department to allow ability to support colleague managers in a range of accountabilities
- Have the flexibility to work in a constantly changing business environment
- Ability to work non-standard business hours in order to execute and deliver within the confines and timeframes provided by CMS
Travel
This position may require occasional travel and attendance at local conferences and meetings.
The Perks:
- Medical / Dental / Vision / Wellness Programs
- Paid Time Off / Company Paid Holidays
- 401K with Company match
- Life and Disability Insurance
- Tuition Reimbursement
- Employee Referral Bonus
This position is eligible for Employee Referral Bonus at Level I
To explore all that MedImpact has to offer, and the greatness you can bring to our teams, please submit your resume to www.medimpact.com/careers
MedImpact, is a privately held pharmacy benefit manager (PBM) headquartered in San Diego, California. Our solutions and services positively influence healthcare outcomes and expenditures, improving the position of our clients in the market. MedImpact offers high-value solutions to payers, providers, and consumers of healthcare in the U.S. and foreign markets.
Equal Opportunity Employer, Male/Female/Disabilities/Veterans
OSHA/ADA:
To perform this job successfully, the successful candidate must be able to perform each essential duty satisfactorily. The requirements listed are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Disclaimer:
The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified.
