Formulary Operations Manager

UNITAS•River Falls, WI

103d

About The Position

The Formulary Operations Manager is responsible for providing operational support for the evaluation, implementation, and maintenance of our standard and custom Commercial and Exchange formularies and utilization management. This individual supports the creation and maintenance of formulary, clinical adjudication list, and utilization management lists, preparation of Exchange JSON formulary submission files and member formulary drug lists, preparation and review of updates for implementation, and other formulary and utilization management related tasks and processes. The role requires strong cross functional collaboration and communication skills, and an understanding of formulary operations processes.

Requirements

Doctor of Pharmacy (PharmD) Degree from an accredited institution, with record of strong academic performance
Current, unrestricted registered pharmacist license(s)
2-3 years of formulary experience working for a health plan or PBM preferred
2-3 years of Medicare experience preferred
Knowledge of formulary development and maintenance processes
Knowledge of highly managed specialty medications/strategy
Knowledge of rebate and financial implications of formulary strategies
Experience working with large datasets preferred
Ability to independently identify, research, and resolve issues
Ability to balance multiple complex projects simultaneously
Ability to work extended hours, weekends, and holidays consistent with industry demands
Exceptional written and verbal communication skills
Extremely flexible, highly organized, and able to shift priorities easily
Attention to detail & commitment to delivering high quality work product
Microsoft office suite with emphasis on Microsoft excel proficiency required

Nice To Haves

Residency/fellowship preferred

Responsibilities

Define, configure, and maintain standard and custom formularies for the Commercial and Health Information Marketplace/Exchange lines of business
Provide client-facing strategic and operational support for the configuration, implementation, maintenance, and quality control of custom formularies, drug lists, custom formulary marketing materials, clinical adjudication lists, and utilization management edits
Evaluate appropriateness and operationalize custom client formulary and benefit requests within the formulary/adjudication platform
Collaborates with teams in a cross-functional environment including, but not limited to; benefit administration, rebate administration, client account management, analytics, software development/product, regulatory/compliance, government programs, member experience, prior authorization operations, and marketing
Develop weekly drug product review and formulary recommendations by assessing drug use trends, new drug releases, and review of primary literature
Analyze pharmacy cost of care, clinical updates, and coordinate the development of appropriate formulary management programs and utilization management edits
Set criteria for medication analysis and coordinate methodology for client requested and regulatory formulary reporting requirements
Evaluate drugs/drug classes and make formulary positioning and utilization management recommendations and formulary management strategies and associated adjudication requirements to operationalize
Provide cross functional support for claim troubleshooting within the adjudication platform
Support comprehensive testing of client formulary and benefit elections
Support formulary change processes within URAC/NCQA/SOC guidelines and requirements
Support client formulary requests, as required
Support quality improvement projects, as required
Support the company pharmaceutical pipeline, as needed
Support Request for Information (RFI) and Request for Proposal (RFP) submissions, as needed
Support general business needs and operations, as required
Responsible for adherence to the company Code of Conduct including reporting of noncompliance