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The position involves overseeing the development and maintenance of custom formularies for all non-Medicare lines of business, including Commercial, Medicaid, and Health Information Marketplace/Exchange. The role requires monitoring and analyzing regulatory and legislative requirements, developing project plans to meet these requirements, and leading cross-functional teams to implement programs accordingly. Additionally, the position entails overseeing the implementation and maintenance of both custom and standard formularies, supporting relationships with external partners and vendors, and facilitating communication and education regarding clinical issues and objectives. The role also includes supervising and coaching direct reports, developing clinical criteria for drug reviews, evaluating drugs and making formulary positioning recommendations, and providing support during implementation. The candidate will analyze prescription claims data to identify opportunities for improvement and support quality improvement and clinical value projects as needed.
