Clinical Account Consultant Pharmacy - Medicare Formulary Strategy
About The Position
At HCSC, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers. Join HCSC and be part of a purpose-driven company that will invest in your professional development. Job Summary The Clinical Acct Consult Pharmacy - Medicare Formulary Strategy is responsible for multiple aspects of the development and execution of Medicare Part D formulary strategy in accordance with CMS 42 C.F.R. §423.100, 120 Prescription Drug Benefit Manual Chapter 6- “Part D Drugs and Formulary Requirements” to ensure the health plan’s formularies meet regulatory requirements and HCSC goals.
Requirements
- Registered Pharmacist
- 4 years of managed care pharmacy experience or 4 years of consulting experience in the pharmacy benefits industry (completion of managed care residency can substitute for 4 years of managed care pharmacy experience requirements)
- Knowledge of pharmacy benefits products, services and concepts
- Analytical skills including developing reports and synthesizing data to tell a story and develop recommendations
- Written and verbal communications skills including developing presentations and presenting to external business leaders or large audiences
- Collaboration skills to work across organization on problem resolution, negotiation, consensus building, conflict management, and decision-making skills
- Relationship building skills to build strong customer relationships
- Project management skills and experience
- Experience with Microsoft Office applications (Word, Excel, PowerPoint) and clinical/business databases
Nice To Haves
- Pharm.D. preferred
- Managed care pharmacy residency
- 2 or more years of Medicare Part D experience
- Knowledge of Medicare Part D regulatory requirements
- Knowledge of computer applications, including pharmacy claims systems
- Proficiency in Microsoft platform functionality (e.g., Word, PowerPoint, Excel)
- Understanding of formulary development and/or maintenance
- Formulary development and strategy experience
Responsibilities
- Contributes to daily, monthly, and annual formulary development activities
- Leads and/or supports Medicare internal formulary development subcommittee discussions and ensures appropriate execution of decisions
- Develops and updates formulary utilization management (UM) criteria: prior authorization (PA), step therapy (ST), and quantity limits (QL)
- Assists in development of annual formularies in collaboration with the Product, Actuary and Contracting departments
- Contributes to the annual Part D bid development by providing formulary files and assumptions, as well as documents required for P&T Committee review and approval
- Ensures complete modeling and evaluation of drug contract offers and act as drug manufacturer clinical point of contact
- Communicates changes to the PBM and ensures execution of formulary strategies
- Collaborates with the Coverage Determination (CD) unit to implement UM changes and develop decision trees for drugs with UM and select non-formulary drugs
- Partners with key stakeholders of formulary strategy outcomes and ensures collaboration to achieve goals
- Assists with formulary submission outlier review process
- Maintains formulary-related policies and procedures and job aids
Benefits
- health and wellness benefits
- 401(k) savings plan
- pension plan
- paid time off
- paid parental leave
- disability insurance
- supplemental life insurance
- employee assistance program
- paid holidays
- tuition reimbursement
- plus other incentives
Stand Out From the Crowd
Upload your resume and get instant feedback on how well it matches this job.
What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
