Formulary Administration Pharmacist

MedImpact Healthcare Systems, Inc.•San Diego, CA

3d•$108,515 - $196,412•Onsite

About The Position

The Formulary Administration Pharmacist manages operational aspects of business unit, department; acts as the subject matter expert (SME) to lead and support the execution of strategic initiatives, projects, and/or programs under guidance of Director and/or Manager, Formulary Administration & Strategy. This position focuses on the efforts of the MedImpact Formulary Administration & Strategy Team in quality control and analysis of MedImpact client formulary set-up, rule sets, coding, accuracy, functionality, EOB, documentation, and concordance with client specified and regulatory requirements utilizing distinct but inter-related management and cross- departmental functions.

Requirements

PharmD and 3+ years’ experience or equivalent combination of education and experience, and 1 year of SME in respective areas
Knowledge of Microsoft Office, Outlook and a working knowledge of relational databases.
Registered Pharmacist in a U.S. state or territory.
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 a variety of instructions furnished in written, oral, diagram, or schedule form.
Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. Ability to compute rate, ratio, and percent and to draw and interpret bar graphs.
Ability to effectively present information in one-on-one and small group situations to customers, clients, and other employees of the organization.
Ability to write routine reports and correspondence.
Ability to speak effectively before groups of customers or employees of 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

Responsibilities

Collaborates with Drug Information, Formulary Strategy, and Configuration Services to translate approved clinical recommendations and formulary strategies into accurate operational implementation.
Oversee the 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.
Maintains knowledge of pharmacy benefit regulatory requirements and ensures compliance with applicable Federal and State regulations across all lines of business (e.g. Commercial and Health Insurance Exchange).
Supports Formulary Administration operations across Commercial, Health Insurance Exchange, and other lines of business as assigned, including: Formulary and utilization management configuration, maintenance, quality control, implementation, and ongoing operational support.
Collaborates with GPS, Compliance and other departments to ensure generation of regulatory compliance, reporting, and submission files.
Collaborates with Formulary Strategy to ensure approved clinical and financial strategies are accurately operationalized and maintained within formulary systems and processes. Participates in meetings as necessary.
Provides operational consultation and implementation support for custom client formulary and utilization management strategies.
Support of Drug Management Committee meetings through operational consultation, documentation, implementation planning, and post-decision execution activities: attend meeting as clinical/operational support.
Collaborates with Drug Information to implement and maintain approved recommendations for drug and utilization management positioning decisions (quantity limits, step edit and prior authorization guidelines) resulting from newly approved indications, therapeutic agents, patent expirations, FDA alerts and drug recalls or withdrawals.
Researches and responds to formulary configuration, coding, implementation, and utilization management operational questions and partners with appropriate stakeholders regarding clinical rationale inquiries.
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 the functions as required. 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 the accuracy, integrity, and synchronization of formulary data across claims adjudication systems, formulary files, regulatory submissions, member-facing materials, and client deliverables through established quality control and validation processes.
Provides direct client consultation regarding formulary administration operations, implementation activities, formulary maintenance, coding processes and related system functionality.
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.
Other duties may be assigned.