Formulary Development Leader - Remote Job at EmblemHealth
$63,000 - $110,000 a year
Summary of Position
- Manage the formulary team. Ensure compliant formulary filings for Medicare, Medicaid, Commercial, HIX in NY and CT.
- Partner with PBM Clinical Account Executives to identify formulary improvement opportunities quarterly. Ensure weekly drug
- Oversee the operational execution of all clinical and formulary decisions, work with operations to test all formulary changes.
Principal Accountabilities
- Deliver the clinical and operational formulary needs of various lines of business such as Commercial, MCO, Medicare,
- Responsible for the administration, communication and implementation of plan formularies.
- Perform drug reviews on new entities, update criteria, make recommendations regarding drug inclusion and utilization
- Ensure pharmacy drug policies are current, accurate and approved by the Pharmacy & Therapeutics Committee.
- Partner with the PBM on all clinical implementations, interface with the pharmacy operations team to ensure
- Ensure quality of the formulary by performing regular reviews of various available reports.
- Oversee and drive pharmacy formulary strategy implementation for the enterprise, including reviewing drug trends,
economics, product, and ESI) to implement formulary strategies.
- Partner with the product teams to identify and implement opportunities for formulary decisions to reduce cost and
- Maintain strong collaborative partnerships with business partners.
- Manage the day to day functions of the Sr. Clinical Pharmacy Specialists ensuring all pharmacy drug changes are
- Manage the team and the formulary calendar ensuring all state and federal submissions are timely and accurate.
- Identify process improvements and strategies to streamline the team's responsibilities and/or increase productivity.
- Update and maintain the team’s SOPs, procedures, and checklists.
- Report formulary compliance to senior leadership.
- Establish strong relationships with Pharma in support of identifying rebate and cost savings opportunities.
Education, Training, Licenses, Certifications
- Doctor of Pharmacy degree.
- PGY-1 or PGY-2 In Ambulatory Care, Geriatrics, Internal Medicine, or Managed Care Preferred
- Registered Pharmacist: New York State pharmacy license or eligible to obtain New York State license within 6 months
Relevant Work Experience, Knowledge, Skills, and Abilities
- A minimum of 10 years of relevant experience. (R)
- 5+ years of pharmacist experience. (R)
- Residency or 5 years’ clinical experience. (P)
- Knowledge of formulary utilization management techniques (R)
- Knowledge of pharmaceuticals and disease states to provide advice and consultation to providers and members, and
- Possess research and analytical skills sufficient to provide problem resolution and consultation to providers (R)
- Excellent verbal and written communication skills sufficient to prepare own correspondence and interact with members and
Additional Information
- Requisition ID: 1000000700
- Hiring Range: $104,000-$140,000
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