The Senior Advisor, Medicare Formulary Management Pharmacist is responsible for providing strategic and operational support for the development, implementation, and evaluation of Medicare Part D formularies, drug lists, and utilization management. This individual must be able to evaluate large, complex data sets and provide recommendations based on the results. The role requires strong cross functional collaboration, superior communication and project management skills and a deep understanding of Medicare Part D formulary management and related processes and applicable CMS rules and regulations.
Responsibilities will include:
1) Development, implementation, and evaluation of Medicare Part D formularies, drug lists, and utilization management.
2) Monitoring the drug pipeline and drug file changes and managing related Medicare Part D drug file and list update processes.
3) Serve as subject matter expert regarding formularies for internal and external stakeholders.
4) Interface with and support internal departments (e.g. Clinical Advisors, Clinical Operations, Account Services, Marketing, Sales, Trade, RFP, Actuary and Analytics) on formulary and UM-related issues, processes, requests, projects, and analysis/reports.
5) Provide formulary and utilization management evaluation and provide documentation for internal business approvals and implementation.
6) Support formulary-related processes, projects, and issues.
Position location open to: Solon, OH, Scottsdale, AZ, Northbrook, IL, Pittsburgh, PA, and Lincoln, RI
- Minimum of seven (7) years experience in a Managed Care environment and five (5) years in Medicare Part D.
- Candidate needs to be licensed pharmacist in state of current residence,
- Ability to prioritize and handle multiple complex projects related to a wide variety of clinical business needs.
- Demonstrates strong strategic thinking and ability to distill strategic concepts into actionable tactics.
- Superior analytical skills, quantitative skills, logic and problem solving skills.
- Ability to work with large data sets, analyze data and provide recommendations based on the analysis.
- Ability to produce results by determining timeframes, deadlines and successive steps.
- Ability to research, analyze, interpret and apply rules and regulations
- Demonstrated success dealing with ambiguity or uncertainty and ability to learn on the fly to understand and solve new problems
- Able to work across boundaries and locations, have attention to detail, and understand the impacts of their function to the organization, clients, and plan participants.
- Demonstrates ability to identify opportunities, define approach, develop project plans and oversee implementation of formulary related projects and services.
- Ability to exercise professional judgment in analyzing and resolving issues.
- Knowledge of the regulatory environment and applicable standards.
- Proficient in MS Word, Excel, Access, and PowerPoint.
Board Certification (any discipline)
Knowledge of RxCLAIM system formulary and UM setup
Bachelors Degree in Pharmacy or Doctor of Pharmacy.
Job ID: 698637BR.