Pharmacist Formulary Strategy & Management

Job Summary:

The Pharmacist – Formulary Strategy and Management researches and develops moderate to complex industry-leading medical and pharmaceutical formularies, criteria, and drug policies that are cost effective and drive best clinical practice.

Essential Functions:

• Perform competitive analysis on our market and line of business formularies to identify opportunities to enhance our formularies
• Develop prior authorization and step therapy criteria and other utilization management edits
• Develop formulary monitoring and reporting tools to ensure appropriate utilization and cost effectiveness of formulary design
• Prepare SERFF and JSON files for submission
• Complete regulatory and market requests as assigned
• Ensure regulatory requirements and submission deadlines are met
• Ensure adherence to company, state, and federal guidelines
• Research clinical and scientific literature and consensus guidelines to create work products for team input
• Support the operational processes of the Pharmacy and Therapeutics, Value Assessment, and Clinical Policy committees and other applicable committees
• Evaluate formulary changes for access to care issues and impact to operational aspects of business
• Support the development and implementation of policies and procedures
• Participate in department initiatives and projects, including relevant pharmacy research projects and educational programs
• Work with health plan business product leaders, specialty companies, and corporate leaders to develop deliverables on pharmacy priorities
• Coordinate with subject matter experts to develop policy positions on issues that impact CareSource from medical and pharmacy criteria and policy perspectives
• Advise and precept APPE students and residents
• Work with business product owners, government relations, and compliance leads to monitor legislative and regulatory activities for potential impact on existing or proposed criteria and policies
• Collaborate with interdisciplinary team members to achieve goals
• Perform any other job-related functions as requested

Education and Experience:

• Bachelors of Science in Pharmacy or PharmD is required
• A minimum of three (3) years of formulary pharmacy experience is required
• Two (2) years of previous health plan or PBM experience strongly preferred

Competencies, Knowledge and Skills:

• Demonstrated advanced computer skills/proficiency with Microsoft Word, Excel, search engines, and bibliographic software
• Knowledge of medical terminology and claims payment policies
• Strong clinical expertise and healthcare administration understanding
• Advanced analytical skills, with the ability to interpret and synthesize complex healthcare literature
• Ability to interpret complex clinical information and apply to policy development
• Excellent verbal and written communications skills
• Excellent presentation and decision-making skills 
• Excellent organization and tracking skills
• Excellent problem solving skills
• Ability to interface and collaborate with employees at all levels
• Ability to handle multiple priorities/projects simultaneously

Licensure …