Formulary Administration Pharmacist

About the role

The Formulary Administration Pharmacist manages operational aspects of business unit, department; acts as the subject matter expert (SME) to lead and support the execution of strategic initiatives, projects, and/or programs under guidance of Director and/or Manager, Formulary Administration & Strategy. This position focuses on the efforts of the SavRx powered by MedImpact Formulary Administration Team in quality control and analysis of MedImpact client formulary set-up, rule sets, coding, accuracy, functionality, EOB, documentation, and concordance with client specified and regulatory requirements utilizing distinct but inter-related management and cross- departmental functions. Essential Duties and Responsibilities include the following. Other duties may be assigned. Maintains, facilitates access to, and distributes clinical formulary information, formulary product descriptions, recommendations for rational drug formulary positioning, application, and revision, when necessary, of standard utilization management, and recommendations regarding client pharmacy benefit expenditures and utilization. Collaborates with Industry Relations for financial strategy, and Configuration Services for operational support. Is knowledgeable of regulatory constraints on the pharmacy benefit and ensures compliance with Federal and State regulations for all line(s) of business (e.g. Medicaid, Commercial, and Health Insurance Exchange). Supports Medicaid/Commercial/Health Insurance Exchange Formulary Administration as follows: Formulary creation and maintenance, utilization management creation and maintenance. Collaborates with GPS, Compliance and other departments to ensure generation of regulatory compliance, reporting, and submission files. Collaborates with Industry Relations to provide clinical oversight and ensure financial strategy is properly operationalized. Participates in meetings as necessary. Support client teams with custom client formulary strategy recommendations. Support of Formulary Decision Review meetings: attend meeting as clinical/operational support. Develops formulary strategy and recommendations such as drug and UM positioning (quantity limits, step edit and prior authorization guidelines) in response to newly approved therapeutic agents, patent expirations, FDA alerts and drug recalls or withdrawals. Researches and appropriately responds to formulary drug placement and UM rationale and coding questions. Manages formulary activities related to MedImpact Standard and Custom formularies. Manages formulary change process including appropriate formulary content, application of utilization management activities, printed formularies, Plan Finder formulary files and the functions as required. Ensures that the review, coding and quality control of formulary changes occur in an appropriate, accurate, and timely manner based on client-specific parameters. Manages formulary activities related to MedImpact Standard and Custom formularies. Manages formulary change process including appropriate formulary content, application of utilization management activities, printed formularies, Plan Finder formulary files and the functions as required. Ensures that the review, coding and quality control of formulary changes occur in an appropriate, accurate, and timely manner based on client-specific parameters. Ensures appropriate, accurate, and consistent client specific formulary claims adjudication, formulary flat file and Plan Finder file concordance. Provides direct client consultation on all Formulary Administration and Strategy operatio

Benefits

Additional Information

Exemption Status: United States of America (Non-Exempt) $52.17 - $73.30 - $94.43 "Pay scale information is not necessarily reflective of actual compensation that may be earned, nor a promise of any specific pay for any selected candidate or employee, which is always dependent on actual experience, education, qualifications, and other factors. A full review of our comprehensive pay and benefits will be discussed at the offer stage with the selected candidate." This position is not eligible for Sponsorship. MedImpact Healthcare Systems, Inc. is looking for extraordinary people to join our team! Why join MedImpact? Because our success is dependent on you; innovative professionals with top notch skills who thrive on opportunity, high performance, and teamwork. We look for individuals who want to work on a team that cares about making a difference in the value of healthcare. At MedImpact, we deliver leading edge pharmaceutical and technology related solutions that dramatically improve the value of health care. We provide superior outcomes to those we serve through innovative products, systems, and services that provide transparency and promote choice in decision making. Our vision is to set the standard in providing solutions that optimize satisfaction, service, cost, and quality in the healthcare industry. We are the premier Pharmacy Benefits Management solution! Job Description

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