Formulary Administration Pharmacist

MedImpact•Fremont, NE

4d•Onsite

About The Position

MedImpact Healthcare Systems, Inc. is seeking an extraordinary Formulary Administration Pharmacist to join their team. This role is crucial for managing the operational aspects of the business unit and acting as a subject matter expert to support strategic initiatives. The position focuses on quality control and analysis of client formulary set-up, rule sets, coding, accuracy, functionality, EOB, documentation, and compliance with client specifications and regulatory requirements. The company emphasizes innovation, high performance, and teamwork, aiming to make a difference in healthcare value through leading-edge pharmaceutical and technology solutions.

Requirements

PharmD and 3+ years’ experience or equivalent combination of education and experience
1 year of SME in respective areas
Knowledge of Microsoft Office, Outlook and a working knowledge of relational databases.
Registered Pharmacist in the State of California or equivalent state.
Ability to learn cross functional operations within the department to allow ability to support colleague managers in a range of accountabilities.
Flexibility to work in a constantly changing business environment.
Ability to work non-standard business hours in order to execute and deliver within the confines and timeframes provided by CMS.
Ability to define problems, collect data, establish facts, and draw valid conclusions.
Ability to interpret an extensive variety of technical instructions in mathematical or diagram form and deal with several abstract and concrete variables.
Ability to work with mathematical concepts such as probability and statistical inference, and fundamentals of plane and solid geometry and trigonometry.
Ability to apply concepts such as fractions, percentages, ratios, and proportions to practical situations.
Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, or governmental regulations.
Ability to effectively present information in one-on-one and small group situations to customers, clients, and other employees of the organization.
Composure
Decision Quality
Organizational Agility
Problem Solving
Customer Focus
Drive for Results
Peer Relations
Time Management
Dealing with Ambiguity
Learning on the Fly
Political Savvy

Nice To Haves

Excellent customer service skills and interpersonal communication skills (listening/verbal/written).
Ability to manage difficult or emotional client situations.
Respond promptly to client needs.
Solicit client feedback to improve service.
Respond to requests for service and assistance from clients.
Meet commitments to clients.

Responsibilities

Maintains, facilitates access to, and distributes clinical formulary information, formulary product descriptions, recommendations for rational drug formulary positioning, application, and revision of standard utilization management, and recommendations regarding client pharmacy benefit expenditures and utilization.
Collaborates with Industry Relations for financial strategy, and Configuration Services for operational support.
Ensures compliance with Federal and State regulations for all lines of business (e.g., Medicaid, Commercial, and Health Insurance Exchange).
Supports Medicaid/Commercial/Health Insurance Exchange Formulary Administration, including formulary creation and maintenance, and utilization management creation and maintenance.
Collaborates with GPS, Compliance, and other departments to ensure generation of regulatory compliance, reporting, and submission files.
Collaborates with Industry Relations to provide clinical oversight and ensure financial strategy is properly operationalized.
Participates in meetings as necessary.
Supports client teams with custom client formulary strategy recommendations.
Supports Formulary Decision Review meetings by attending as clinical/operational support.
Develops formulary strategy and recommendations such as drug and UM positioning (quantity limits, step edit and prior authorization guidelines) in response to newly approved therapeutic agents, patent expirations, FDA alerts and drug recalls or withdrawals.
Researches and appropriately responds to formulary drug placement and UM rationale and coding questions.
Manages formulary activities related to MedImpact Standard and Custom formularies.
Manages formulary change process including appropriate formulary content, application of utilization management activities, printed formularies, Plan Finder formulary files and required functions.
Ensures that the review, coding and quality control of formulary changes occur in an appropriate, accurate, and timely manner based on client-specific parameters.
Ensures appropriate, accurate, and consistent client-specific formulary claims adjudication, formulary flat file and Plan Finder file concordance.
Provides direct client consultation on all Formulary Administration and Strategy operations, programs, and software.
Responsible for accurate and timely task estimation and status reporting to Director/Manager, Formulary Administration & Strategy.
Provides formulary-specific documentation of maintenance activities to clients and regulatory bodies as appropriate.
Partners with other departments on a weekly, quarterly and ad hoc basis on the Formulary decision process.
Contributes to internal and external client notifications of timely clinical issues through daily, monthly and quarterly established communications.