Formulary Administration Pharmacist

“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.”

This position is not eligible for Sponsorship.

Summary

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 the 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.

Essential Duties and Responsibilities include the following. Other duties may be assigned.

• Collaborates with Drug Information, Formulary Strategy, and Configuration Services to translate approved clinical recommendations and formulary strategies into accurate operational implementation. Oversee the coding, maintenance, quality control, validation, documentation, and distribution of formulary and utilization management data to ensure consistency across claims adjudication, formulary files, regulatory submissions, and client deliverables. Maintains knowledge of pharmacy benefit regulatory requirements and ensures compliance with applicable Federal and State regulations across all lines of business (e.g. Commercial and Health Insurance Exchange).

• Supports Formulary Administration operations across Commercial, Health Insurance Exchange, and other lines of business as assigned, including:

• • Formulary and utilization management configuration, maintenance, quality control, implementation, and ongoing operational support.
  • Collaborates with GPS, Compliance and other departments to ensure generation of regulatory compliance, reporting, and submission files.
  • Collaborates with Formulary Strategy to ensure approved clinical and financial strategies are accurately operationalized and maintained within formulary systems and processes. Participates in meetings as necessary.
  • Provides operational consultation and implementation support for custom client formulary and utilization management strategies.
  • Support of Drug Management Committee meetings through operational consultation, documentation, implementation planning, and post-decision execution activities: attend meeting as clinical/operational support.
  • Collaborates with Drug Information to implement and maintain approved recommendations for drug and utilization management  positioning decisions (quantity limits, step edit and prior authorization guidelines) resulting from newly approved indications, therapeutic agents, patent expirations, FDA alerts and drug recalls or withdrawals.
  • Researches and responds to formulary configuration, coding, implementation, and utilization management operational questions and partners with appropriate stakeholders regarding clinical rationale inquiries.
  • Manages formulary activities related to MedImpact Standard and Custom formularies. Manages formulary change process including appropriate formulary content, application of utilization management activities, printed formularies, Plan Finder formulary files and the 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 the accuracy, integrity, and synchronization of formulary data across claims adjudication systems, formulary files, regulatory submissions, member-facing materials, and client deliverables through established quality control and validation processes.
  • Provides direct client consultation regarding formulary administration operations, implementation activities, formulary maintenance, coding processes and related system functionality.
  • Responsible for accurate and timely task estimation and status reporting to Director/Manager, Formulary Administration & Strategy. 
  • Provides formulary-specific documentation of maintenance activities to clients and regulatory bodies as appropriate.
  • 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.

• Other duties may be assigned.

Supervisory Responsibilities        

No supervisory responsibilities

Education and/or Experience

PharmD and 3+ years’ experience or equivalent combination of education and experience, and 1 year of SME in respective areas

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 a U.S. state or territory.

Other Skills and Abilities

• Advanced Microsoft Excel skills, including data validation, pivot tables, formulas, analysis, and reconciliation of large datasets.

• Demonstrated ability to manage multiple projects and priorities, lead cross-functional initiatives, and drive work to completion with minimal supervision.

Reasoning Ability

• Ability to define problems, collect data, establish facts, and draw valid conclusions.

• Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.

Mathematical Skills

• Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals.  Ability to compute rate, ratio, and percent and to draw and interpret bar graphs.

Language Skills

• Ability to effectively present information in one-on-one and small group situations to customers, clients, and other employees of the organization.

• Ability to write routine reports and correspondence.  Ability to speak effectively before groups of customers or employees of organization.

Competencies To perform the job successfully, an individual should demonstrate the following competencies:

Composure

Decision Quality

Organizational Agility

Problem Solving

Customer Focus

Drive for Results

Peer Relations

Time Management

Dealing with Ambiguity

Learning on the Fly

Political Savvy

Physical Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is regularly required to sit and talk or hear. The employee is regularly required to stand; walk; use hands to finger, handle, or feel and reach with hands and arms. The employee must occasionally lift and/or move up to 25 pounds. Ability to maintain clear near visual acuity at approximately 20 inches or less (i.e., “close vision”) to accurately read fine print, view computer screens, and handle small objects. Requires adequate color vision and depth perception to support safety and precision in detail-oriented tasks.

Work Environment

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.

This position may regularly be exposed to or encounter moving mechanical parts, high, precarious places, fumes, or airborne particles, toxic or caustic chemicals, outdoor weather conditions, risk of electrical shock or vibration. The noise level in the work environment is usually moderate (examples: business office with computers and printers, light traffic).

Work Location

This position works on-site at the San Diego Headquarters or other company location (or from a remote location with management approval based on business requirements). Must provide adequate support to internal clients; be available for regular interactions and coordination of work with other employees, colleagues, clients, or vendors; as well as be available to facilitate effective decisions through collaboration with stakeholders.

Working Hours

This is an exempt level position requiring the incumbent to work the hours required to fully accomplish job responsibilities and meet deadlines for work deliverables. The individual must have the flexibility to work beyond traditional hours and be able to work nights, weekends or on holidays as required. Work hours may be changed from time to time to meet the needs of the business. Typical core business hours are Monday through Friday from 8:00am to 5:00pm.

Travel

This position does not require any travel.

• Medical / Dental / Vision / Wellness Programs

• Paid Time Off / Company Paid Holidays

• Incentive Compensation

• 401K with Company match

• Life and Disability Insurance

• Tuition Reimbursement

• Employee Referral Bonus

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