Clinical Pharmacist, Formulary Services
About The Position
Abarca is seeking a Clinical Pharmacist for Formulary Services to join their revolution in healthcare. This role is responsible for developing and implementing formulary programs for Medicare, Medicaid, and Exchange plans, ensuring compliance with regulatory guidelines. The position involves resolving complex adjudication and processing issues, conducting client-facing demonstrations of the PBM configuration platform, and leading configuration setup for new client implementations and changes. The pharmacist will also provide consultative support, manage team workload, identify efficiency improvements in inventory management, and collaborate with internal teams. A key aspect of the role includes managing client benefit operational calls and meetings, developing an in-depth understanding of the proprietary Darwin adjudication platform, and participating in the Pharmacy & Therapeutics Committee. The role also requires staying informed about formulary and benefit design trends, participating in audits, engaging in CMS Medicare STAR initiatives, and leading process improvement efforts. Additionally, the pharmacist will develop process documentation and train new team members.
Requirements
- Doctoral Degree in Pharmacy.
- Current/Active Pharmacy License.
- 3+ years of experience with formulary management within clinical operations, and pharmacy benefit management.
- Experience working within clinical scenarios.
- Excellent oral and written communication skills.
- Flexible hybrid work model which will require certain on-site work-days (Puerto Rico Location Only).
- Availability to work in a specified time zone or working schedule, accommodating the business needs of our clients and team members.
- Availability for on-call hours, including evenings, weekends, and holidays, to promptly address emergent issues or provide necessary support as dictated by operational demands (if applicable).
Nice To Haves
- Experience with pharmacy benefit management clinical operations and Medicare Part D.
- Master’s Degree.
Responsibilities
- Develop and implement Medicare, Medicaid, and Exchange formulary programs.
- Stay current with external regulator guidelines to make timely adjustments to operations ensuring our processes follow the rules and regulations.
- Independently perform as well as consult and advise the team through research and resolution of adjudication and processing issues including, identification of root cause, impact analysis determination and corrective action.
- Resolution & Ownership of project-based work as assigned.
- Perform client or prospect client facing to present demos around the PBM configuration platform.
- Primary support for configuration setup for new Medicare, Medicaid, Commercial and Employer client implementations, as well as configuration changes for existing clients.
- Provide consultative support to clients as well as internal teams.
- Monitor and distribute the workload assignment of the configuration team.
- Identify opportunities and solutions in inventory management that advance efficiency and standards for configuration.
- Collaborate and coordinate both within the configuration teams and with other business units to execute configuration as required.
- Manage client benefit operational calls, key client meetings and requests by capturing significant discussion topics and action items as well as sharing input and solutions to address client needs., considering Abarca’s priorities.
- Continuously develop and maintain an in-depth understanding of Darwin (proprietary adjudication platform) system logics to ensure designs are configured to meet client requirements with accuracy.
- Take part in the Pharmacy & Therapeutics Committee preparing presentations and clinical recommendations for new drugs.
- Research and remain informed of current and emerging trends in formulary and benefit design.
- Actively participate in government and internal audits.
- Engage in CMS Medicare STAR initiatives and clinical programs, as well as Medicare Plan Finder and PDE processes.
- Lead the team through process improvement efforts and recommendations.
- Develop process documentation, including Policies and Procedures, to document Benefit Administration operational processes.
- Support training new team members in configuration setup and standardized quality procedures.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
Ph.D. or professional degree
