Formulary Administration Pharmacist

MedImpact•San Diego, CA

About The Position

The Formulary Administration Pharmacist manages operational aspects of the business unit and serves as a subject matter expert supporting strategic initiatives, projects, and programs under the guidance of the Director and/or Manager, Formulary Administration & Strategy. The position focuses on quality control and analysis of client formulary setup, rule sets, coding, accuracy, functionality, explanation of benefits (EOB), documentation, and alignment with client specifications and regulatory requirements. The role supports formulary administration across Commercial, Health Insurance Exchange, and other assigned lines of business. It works with Drug Information, Formulary Strategy, Configuration Services, GPS, Compliance, and other departments to operationalize approved clinical and financial strategies; maintain accurate formulary and utilization management data; support regulatory submissions and reporting; and provide implementation and operational consultation to clients. The position also supports Drug Management Committee activities and related communications, documentation, and implementation planning. This is an exempt position based on-site at the San Diego Headquarters or another company location, with remote work possible with management approval based on business requirements. Typical core hours are Monday through Friday, 8:00 a.m. to 5:00 p.m.; the incumbent must be flexible to work beyond traditional hours, including nights, weekends, or holidays, as required. The position does not require travel and has no supervisory responsibilities.

Requirements

PharmD and at least 3 years of experience, or an equivalent combination of education and experience.
At least 1 year of subject matter expert experience in the respective areas.
Registered Pharmacist in a U.S. state or territory.
Knowledge of Microsoft Office and Outlook, and working knowledge of relational databases.
Advanced Microsoft Excel skills, including data validation, pivot tables, formulas, analysis, and reconciliation of large datasets.
Demonstrated ability to manage multiple projects and priorities, lead cross-functional initiatives, and drive work to completion with minimal supervision.
Ability to define problems, collect data, establish facts, and draw valid conclusions.
Ability to interpret instructions furnished in written, oral, diagram, or schedule form.
Ability to perform basic arithmetic and compute rates, ratios, and percentages, and to draw and interpret bar graphs.
Ability to present information effectively to customers, clients, and employees, including in group settings; write routine reports and correspondence; and speak effectively before groups.
Ability to perform the essential physical functions of the job, with reasonable accommodation where applicable, including sitting, talking, hearing, standing, walking, handling objects, reaching, and occasionally lifting or moving up to 25 pounds.
Ability to maintain close vision for reading fine print and viewing computer screens, and adequate color vision and depth perception for detail-oriented tasks.
Flexibility to work beyond traditional hours and nights, weekends, or holidays as required.
Ability to support internal clients and participate in regular work coordination and collaboration with employees, colleagues, clients, or vendors.

Responsibilities

Collaborate with Drug Information, Formulary Strategy, and Configuration Services to translate approved clinical recommendations and formulary strategies into accurate operational implementation.
Oversee coding, maintenance, quality control, validation, documentation, and distribution of formulary and utilization management data to ensure consistency across claims adjudication, formulary files, regulatory submissions, and client deliverables.
Maintain knowledge of pharmacy benefit regulatory requirements and ensure compliance with applicable federal and state regulations across lines of business.
Support formulary and utilization management configuration, maintenance, quality control, implementation, and ongoing operational support across Commercial, Health Insurance Exchange, and other assigned lines of business.
Collaborate with GPS, Compliance, and other departments on generation of regulatory compliance, reporting, and submission files.
Work with Formulary Strategy to ensure approved clinical and financial strategies are accurately operationalized and maintained in formulary systems and processes.
Provide operational consultation and implementation support for custom client formulary and utilization management strategies.
Support Drug Management Committee meetings through operational consultation, documentation, implementation planning, and post-decision execution; attend meetings as clinical and operational support.
Work with Drug Information to implement and maintain approved drug and utilization management positioning decisions, including quantity limits, step edits, and prior authorization guidelines related to new indications, therapeutic agents, patent expirations, FDA alerts, and drug recalls or withdrawals.
Research and respond to formulary configuration, coding, implementation, and utilization management operational questions, and coordinate with stakeholders on inquiries regarding clinical rationale.
Manage activities related to MedImpact Standard and Custom formularies.
Manage the formulary change process, including formulary content, utilization management activities, printed formularies, Plan Finder formulary files, and related functions.
Ensure formulary changes are reviewed, coded, and quality-controlled accurately and on time according to client-specific parameters.
Ensure formulary data is accurate, integral, and synchronized across claims adjudication systems, formulary files, regulatory submissions, member-facing materials, and client deliverables through quality control and validation processes.
Provide direct client consultation on formulary administration operations, implementation, maintenance, coding processes, and related system functionality.
Provide accurate and timely task estimates and status reports to the Director/Manager, Formulary Administration & Strategy.
Provide clients and regulatory bodies with documentation of formulary-specific maintenance activities as appropriate.
Partner with other departments weekly, quarterly, and as needed on the formulary decision process.
Contribute to timely internal and external client notifications about clinical issues through established daily, monthly, and quarterly communications.
Perform other duties as assigned.