Medicare Part D Formulary Manager (Pharmacist)

Univera Healthcare•Binghamton, NY

18d

About The Position

This pharmacist clinician is a program manager, who is responsible for all Medicare Part D formulary creation and submissions, which includes utilization management criteria development for the current and upcoming contract years. This individual creates and executes the Medicare Part D formulary, delivering value and quality to the Plan’s Part D enrollees, while ensuring the longevity of the Plan’s Part D program.

Requirements

Unrestricted NYS Licensed Pharmacist.
Pharm.D. In lieu of a Pharm.D., a Bachelors in Pharmacy is required with a minimum of three (3) years’ experience in a managed care setting.
Experience in Medicare Part D is strongly preferred.
Proficiency in Microsoft Excel preferred.
Ability to articulate complex information in a manner that can be understood by various internal and external target audiences.
Possesses the confidence to think and act differently.
Demonstrates ability to thoughtfully challenge the status quo related to clinical and operational strategies and processes.
Ability to work prolonged periods sitting and/or standing at a workstation and working on a computer.
Ability to work while sitting and/or standing at a workstation viewing a computer and using a keyboard, mouse and/or phone for three (3) or more hours at a time.
Ability to work in a home office for continuous periods of time for business continuity.
Ability to travel across the Health Plan service region for meetings and/or trainings as needed.
Ability to lift, carry, push, or pull 15 pounds or less.
Manual dexterity including fine finger motion required.
Repetitive motion required.
The ability to hear, understand, and speak clearly while using a phone, with or without a headset.

Nice To Haves

Expertise and background with Federal and state regulatory agencies (CMS, DOH, DFS, etc.) and/or accreditation agencies (NCQA, BCBSA) is preferred, but not required.

Responsibilities

Develops and maintains the Part D formulary in collaboration with strategic business partners, which include trade relations, finance, and sales to maximize savings, ensure quality, and minimize member disruption, while incorporating all CMS Part D guidance
Manages all CMS Part D Formulary requirements to ensure deadlines are met.
Works in conjunction with the Pharmacy Benefit Manager (PBM) and Formulary Management software vendor to execute on all formulary-related tasks.
Collaborates with cross-functional management teams within the organization to align and prioritize Medicare objectives across the organization to ensure success within the framework of the Medicare STARS ranking system and deliver value to enrollees.
Creates and operationalizes Medicare Part D criteria for all utilization management requirements in alignment with the Utilization Management Team.
Obtains endorsement of the Medicare Part D formulary program elements from the Pharmacy and Therapeutics Committee.
Oversees the production of CMS formulary model materials in partnership with Medicare Sales and Marketing.
Works in conjunction with the outside vendor as needed to complete all formulary-related tasks.
Supports and educates inter-departmental staff (clinicians, customer care, sales) and external customers (members, brokers) with respect to Part D formulary, utilization management edits, and CMS Part D program guidance, as appropriate.
Reviews, formulates, and executes corrective action plans in conjunction with Medicare Compliance for all formulary-based findings.
Supports and acts as subject matter expert for CMS formulary-based audits.
Acts as a subject matter expert for clinical strategy initiatives designed to improve quality and affordability for Medicare beneficiaries.
Contributes to clinical strategy initiatives within the Pharmacy Department and across the enterprise, which serve to improve quality and affordability for Medicare beneficiaries.
Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies’ mission and values, adhering to the Corporate Code of Conduct and leading to the Lifetime Way values and beliefs.
Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures.
Regular and reliable attendance is expected and required.
Performs other functions as assigned by management.