Clinical Formulary Management Pharmacist - Remote

Prime Therapeutics•Home, WV

1d•$108,000 - $184,000•Remote

About The Position

The Formulary Pharmacist supports the clinical and operational formulary needs of multiple lines of business, including Managed Medicaid. The role evaluates new drugs and drug classes, develops formulary and utilization management recommendations, and supports Pharmacy and Therapeutics and other drug evaluation committees. It implements and maintains formularies, criteria, adjudication, communications, and publications to ensure approved changes are accurately and consistently reflected.

Requirements

PharmD or Bachelor of Science Pharmacy degree.
One year of pharmacy experience as a pharmacist in a retail, mail order, health plan, PBM, or similar setting.
Current pharmacist license to practice in the applicable state(s).
Must be eligible to work in the United States without the need for work visa or residency sponsorship.
Knowledge of prescription drugs, disease states, therapeutic classes, formulary management techniques, prescription benefit designs, and current healthcare industry trends.
Strong project management, prioritization, and organizational skills in an environment with changing priorities and multiple concurrent assignments.
Ability to meet short turnaround times and manage deadline-driven work with minimal oversight.
Excellent written and verbal communication skills, including the ability to communicate clinical and business information to varied audiences.
Strong analytical and problem-solving skills with consistent attention to detail and quality.
Ability to work collaboratively across teams while independently managing day-to-day responsibilities.
Ability to quickly learn computer systems and software; proficiency in Microsoft Office Suite, including Word, Excel, and PowerPoint.
Must understand, comply with, and attest to the security responsibilities and controls unique to the job, as well as applicable legal, regulatory, contractual, and internal requirements.
Must be able to perform the essential functions of the job; reasonable accommodations may be made for employees with disabilities absent undue hardship.

Nice To Haves

Experience with health plan, PBM, Managed Medicaid, formulary operations, drug review committees, or utilization management.
Experience with formulary adjudication, clinical criteria implementation, prescription drug list publishing, or pharmacy data analysis.
Experience with Microsoft Visio or Access.

Responsibilities

Manage formularies and clinical criteria for claims adjudication, prescription drug lists, websites, and related publications in alignment with drug review committee decisions and client requests.
Participate in clinical and financial drug review committees; perform drug and class reviews and develop recommendations for formulary placement and utilization management criteria.
Research and explain clinical and business considerations related to drugs, drug classes, and formulary strategies, and provide subject matter expertise to resolve formulary issues.
Monitor weekly drug files for new products and apply appropriate drug statuses and formulary placement.
Perform routine formulary quality reviews using available reports and pharmacy data to identify and resolve discrepancies.
Develop and coordinate communications for members, clients, prescribers, pharmacies, and internal stakeholders regarding formulary changes.
Serve as a liaison among clinical, operational, technical, client, and publishing teams to support end-to-end formulary management.
Maintain committee documentation and action items, and develop team procedures, checklists, and operational best practices.
Perform other duties as assigned.