Formulary Administration Specialist

MedImpact Healthcare Systems, Inc.•San Diego, CA

2d•$60,987 - $100,628•Hybrid

About The Position

The Formulary Administration Specialist I participates in the design and validation of pharmacy benefit management plans. The role ensures accurate coding of plan-specific information into formulary systems and provides comprehensive support to external clients related to formulary change requests. It helps maintain service levels that meet corporate performance and quality standards. This is an internal- and external-client-facing position requiring strong customer service and interpersonal communication skills. The position has no supervisory responsibilities. The role supports drug update projects, formulary mailbox and client platform inquiries, negative formulary change processes, formulary setup, and claims analysis. The incumbent develops knowledge of formulary and PBM operations through on-the-job training, internal educational opportunities, and external seminars or coursework. The job is based on-site at the San Diego Headquarters or another company location, or remotely with management approval based on business requirements. Domestic travel may be required up to 5% of the time. It is an exempt-level role whose hours may extend beyond traditional hours, including nights, weekends, or holidays as required; typical core business hours are Monday through Friday, 8:00 a.m. to 5:00 p.m.

Requirements

Associate’s degree and at least 2 years of experience, or an equivalent combination of education and experience.
Current Pharmacy Technician License and/or unrestricted CPhT certification.
Good working knowledge of Microsoft Office Suite, including Word, Excel, and Outlook, and good familiarity with databases.
Basic PBM knowledge, drug information and prior authorization experience are preferred qualifications stated in the posting.
Good written and verbal communication and interpersonal skills, with the ability to work cohesively on a team.
Ability to manage multiple priorities, follow tasks through to completion, and maintain attention to detail.
Ability to interpret instructions in written, oral, diagram, or schedule form.
Ability to perform basic arithmetic and calculate rates, ratios, and percentages, and to draw and interpret bar graphs.
Ability to present information effectively in one-on-one and small-group situations; write routine reports and correspondence; and speak effectively before groups of customers or employees.
Must be able to work the hours required to accomplish responsibilities and meet deadlines, with flexibility to work beyond traditional hours, including nights, weekends, or holidays as required.
Must be available for regular interactions and coordination with employees, colleagues, clients, or vendors and facilitate decisions through stakeholder collaboration.
Must be able to travel domestically up to 5% of the time.
Physical requirements include regularly sitting, talking or hearing, standing, walking, using hands to handle or feel items, and reaching with hands and arms; occasionally lifting or moving up to 25 pounds; and maintaining close visual acuity, adequate color vision, and depth perception.

Nice To Haves

Familiarity with National Drug Data Provider products.
Medicare Part D formulary knowledge.
Basic PBM knowledge and drug information and prior authorization experience.

Responsibilities

Review weekly, monthly, and quarterly drug update projects for commercial clients.
Prepare weekly, monthly, and quarterly formulary files for pharmacist review.
Monitor and update Drug Rules and Auto-Coding rules.
Research and respond to client inquiries, escalating complex issues to managers or pharmacists.
Triage inquiries through the formulary mailbox and client management platform, troubleshoot basic issues, and escalate complex issues to managers or pharmacists.
Draft client communications for management review; customize templates with client instructions, including clarification of roles and responsibilities between MedImpact and the client; and prepare routine responses to email and case queries.
Compile member disruption reports for pharmacist review as part of the negative formulary changes process.
Review member letters before distribution.
Build formulary shells with pharmacists.
Provide claims analysis support.
Develop understanding of formulary and PBM operations through on-the-job training, internal education, and external seminars or coursework.
Perform other duties as assigned.
Manage client situations, respond promptly to client needs and requests, solicit feedback to improve service, and meet commitments to clients.