The Supervisor, Formulary Administration & Strategy manages the operational aspects of Formulary Administration and supportsstrategic initiatives, projects, and/or programs. This position focuses on efforts of the MedImpact Formulary Administration 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.
- Oversees and leads a team of licensed Pharmacists
- Provides management and supervision for the team by directing and coordinating activities consistent with established departmental goals, objectives, and policies
- Manages the employee life-cycle from hiring, onboarding, mentoring, training and development of staff members. Meets regularly with team members to provide feedback and coaching. Takes appropriate corrective action as needed to promote optimal employee performance and low staff turnover
- Provides clinical, operational and supervisory guidance and oversight to Formulary Administration staff
- Collaborate with MedImpact’s Government Program Services, Drug Information, Prior Authorization, Benefits, Rebates, Clinical Analytics, and Clinical Consulting teams to ensure accurate, cost-effective and up-to-date formulary content
- Participates in managing the formulary maintenance activities related to the Standard and Custom formularies:
- Oversees routine formulary updateprocesses as well as formulary document submission process to CMS/States.
- Participates in pre-planyear and end-of-the yearprocesses.
- Participates and supportsauditprocesses as a clinical subject matter expert; provides necessary information, documentation and analysis required by audits; support departmental and corporate development of auditsupportinfrastructure
- Promotes rational and appropriate drug use in the member population:
- Formulary drug placement
- Appropriate utilization management edits (e.g. quantity limits, step therapy criteria, prior authorization criteria/guidelines)
- Ensures appropriate, accurate and consistent client specific formulary claims adjudication, formulary flat file and Plan Finder file concordance
- Provides direct client consultation on formulary maintenance operations, programs, and software for any line(s) of business managed within MedImpact’s formulary management software
- Coordinates quality control and analytics related to MedImpact Standard and Custom formulary change process 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 formularies. Provides direct client consultation on CMS/States statutory regulations and CMS/States issued regulatory guidance to ensure continued CMS/States formulary approval
- Supports the 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
- Establish and maintain a process to provide Explanation of Benefits formulary changes to formulary clients as appropriate
- Support colleague managers in a range of accountabilities by being versed in cross-functional operations within the department
- Operates with flexibility in a changing business and government regulated environment
Education and/or Experience
For consideration, candidates will need a Pharm.D. from an accredited school of pharmacy along with five (5) plus years job related experience and/or training; or equivalent combination of education and job related experience. Prior lead or supervisory experience is a plus.
Certificates, Licenses, Registrations
Registered Pharmacist in the State of California (or equivalent)
To perform this job successfully, an individual should have knowledge of Microsoft Office Suite and a working knowledge of relational databases.
Other Skills and Abilities
- Prior experience in PBM/Benefits Services formulary setup and maintenance, relational and analytical database management programs, as well as, familiarity with First Data Bank and/or Medispan drug files are desirable
- Prior experience with Medicare Part D, Medicaid, Marketplace and/or Commercial formulary development and maintenance processes desirable
- Must be able to execute and deliver within the confines and timeframes provided by CMS/States which may include non-standard business hours
- Adaptability/flexibility to work with changing directives in a dynamic environment
- Excellent communications (verbal/written) with the ability to speak in front of groups