Specialist II, Formulary Operations

Navitus Health Solutions, LLC

2d•Remote

About The Position

Due to growth, we are adding a Specialist II, Formulary Operations to our team! The Specialist II, Formulary Operations will perform the daily, weekly, and monthly/periodic administrative functions relative to updating and maintaining the various formularies for Navitus’ clients. This includes all the duties of the Specialist II, Formulary Operations I, plus making decisions on how formularies are built and maintained in the claims processing system which directly affects the financial performance of our services to our clients, their bottom line, and the retention of the Navitus client base. The Specialist II, Formulary Operations will work closely with the Navitus Benefit Systems Architects (BSAs) and the Navitus clinical team to coordinate and operationalize all changes to the formulary including drug tiering and utilization edits such as step therapy and quantity limits.

Requirements

A minimum of a High School diploma plus specialized knowledge relating to pharmacy practice and business software applications is required
CPhT certification and experience as a pharmacy technician is required
2-5 years’ experience working with formulary information; proven analytical, problem solving and written and verbal communication skills
Experience in PBM / Managed health care claims processing strongly preferred
Proficient in Word and Excel
Must be comfortable communicating with vendors, outside and internal customers
Must have a working knowledge of pharmacy practice including drug names (brand vs. generic, NDC, GPI) and claims processing background (either from managed care or from community practice)
Experience with maintenance of formulary setup and documents
Participate in, adhere to, and support compliance program objectives
The ability to consistently interact cooperatively and respectfully with other employees

Responsibilities

Operationalize formulary information from various sources including FAC, P&T, Medispan and CAEs to coordinate the process of getting the information into the Formulary and Benefit Management System (FBMS) and then communicated to Benefits Systems and Auditing
Coordinate implementation schedule of new clients
Work with implementation team to streamline process for new client implementations
Coordinate creating and building of unique formulary designs for custom clients
Make independent decisions on formulary setup and maintenance when creating and building new formulary designs for custom clients which directly affects the bottom line of our clients
Coordinate formulary document creation and posting, including maintenance of web, e-prescribing, formularies, change notifications, and medication program lists
Trouble-shoot various formulary/set-up questions
Review weekly Medispan Reports for specific changes that would affect the formulary
Approximate travel required (5-10%)
Other duties as assigned