Manager, Formulary & Medical Pharmacy Operations

Oscar Health Insurance-posted about 2 months ago
$144,000 - $189,000/Yr
Full-time • Manager
Remote • Dallas, TX
1,001-5,000 employees
Insurance Carriers and Related Activities
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You will oversee and manage clinical pharmacy initiatives driving affordability savings including core formulary management operations. You will partner across Pharmacy, Medical Economics, and the Office of Clinical Affairs to operationalize pharmacy related workflows and monitor existing savings initiatives for drugs on both the pharmacy and medical benefits. You will report to the Senior Manager, Formulary Operations and Pharmacy Utilization Management.

  • Provide insights and recommendations for trend management and clinical effectiveness, including serving as a key contributor in the enterprise affordability process for pharmacy
  • Manage the pipeline of enterprise affordability projects across the pharmacy department (program operations and clinical) and oversee the performance of active initiatives
  • Partner with leads across the organization as necessary in order to communicate, understand and identify upstream and downstream impacts to the business
  • Contribute to the design and implementation of clinical programs focused on improving patient outcomes and reducing costs.
  • These programs may include medication adherence initiatives, chronic disease management programs, and patient education efforts
  • Operationalize, develop and maintain a clinically appropriate and cost-effective formulary by operating and managing Oscar's P&T committee, which includes evaluating new developments in the drug treatment landscape and providing recommendations on how to manage new to market drugs and new drug indications.
  • Oversee and optimize medical pharmacy preferred drug lists and strategies to supports utilization of lowest unit cost infusion products
  • Provide written recommendations with responses and corresponding documentation for regulatory inquiries, feedback on future legislation, and other business questions that probe at formulary operations.
  • Accountable and responsible for maintaining mental health parity NQTL responses and working cross-functionally for future filings and responding to ongoing objections during the audit process.
  • Compliance with all applicable laws and regulations
  • Other duties as assigned
  • Doctor of Pharmacy degree (PharmD)
  • 4+ years working for PBM or Payer in clinical pharmacy operations
  • 4+ years leading cross-functional teams/projects and change management
  • 3+ years supporting formulary management (P&T Committee, clinical policy development, formulary run operations)
  • Residency Training
  • Experience with Marketplace Exchange and Medicare Advantage
  • You are also eligible for employee benefits, participation in Oscar's unlimited vacation program and annual performance bonuses.
  • medical, dental, and vision benefits
  • 11 paid holidays
  • paid sick time
  • paid parental leave
  • 401(k) plan participation
  • life and disability insurance
  • paid wellness time and reimbursements
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