Formulary Administration Pharmacist

Exemption Status:

“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

Summary: 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 efforts of the MedImpact Formulary Administration & Strategy 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:

• 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. Medicare Part D, Medicaid, Commercial, and Health Insurance Exchange).
• Supports Medicare Part D formulary administration as follows:
• Promotes rational and appropriate drug use in the Medicarepopulation.
• Provides direct client clinical consultation relative to formulary drug placement, appropriate utilization management edits and related client specific documents for Step Therapy and Prior Authorization Guidelines required by CMS/States. Provides direct client consultation on;
• All formulary maintenance operations, programs, software, CMS/States statutory regulations, and CMS/States issued regulatory guidance to ensure continued CMS/States formulary approval.
• Coordinates quality control and analytics related to MedImpact Standard and Custom formulary changes including appropriate formulary content, application of utilization management activities, printed formularies, Plan Finder formulary files and other 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 compliance with regulatory requirements for all formularies.
• 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.
• Partners with other departments on a weekly, quarterly and ad hoc basis on the Formulary decision process. Contributes to internal and external client notifications of timely clinical issues through daily, monthly and quarterly established communications.
• Supports MedImpact Standard and Custom formulary print functions in accordance with CMS/States regulatory statute and guidance. Reviews new drug categorization changes to customize, implement, and integrate with MedImpact printed formulary products as appropriate.
• Provides formulary-specific documentation of maintenance activities to clients and regulatory bodies as appropriate.
• Collaborates with Government Program Services (GPS) to provide Explanation of Benefits formulary changes to Medicare Part D formulary clients as appropriate.

Supervisory Responsibilities

This job has no supervisory responsibilities.

Client Responsibilities

This is an internal and external client facing position that requires excellent customer service skills and interpersonal communication skills (listening/verbal/written). One must be able to respond promptly to client needs, solicit client feedback to improve service, respond to requests for service and assistance from clients, meet commitments to clients, and manage difficult or emotional client situations.

Qualifications

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education and Experience

Doctor of Pharmacy (PharmD.) from an accredited school of pharmacy (or equivalent such as a Bachelors, Pharmacy and a RPh license) along with 2 - 5+ years’ related experience. Prior PBM industry experience is preferred with specific experience in PBM/Benefits Services formulary setup/maintenance as well as experience with standardizing and streamlining work processes.

Computer Skills

To perform this job successfully, an individual should have knowledge of Microsoft Office, Outlook and a working knowledge of relational databases.

Certificates, Licenses, Registrations

Registered Pharmacist in the State of California or equivalent state

Other Desired Skills and Abilities

• Ability to learn cross functional operations within the department to allow ability to support colleague managers in a range of accountabilities.
• Have the flexibility to work in a constantly changing business environment.
• Ability to work non-standard business hours in order to execute and deliver within the confines and timeframes provided by CMS.

Reasoning Ability

Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.

Mathematical Skills Candidates must have an understanding of pharmaceutical calculations including fractions, decimals, ratios, proportions, percentages, and medication dosing. In addition, candidates must have the ability to calculate and/or interpret market shares and graphs.

Language Skills Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, or governmental regulations. Ability to write reports, policies and procedures, and business correspondence. Ability to effectively present information and respond to questions from groups of managers, clients, and customers.

Competencies

To perform the job successfully, an individual should demonstrate the following competencies:

• Analytical - Synthesizes complex or diverse information; Collects and researches data; Uses intuition and experience to complement data.
• Problem Solving - Identifies and resolves problems in a timely manner; Gathers and analyzes information skillfully; Develops alternative solutions; Uses reason even when dealing with emotional topics.
• Customer Service - Manages difficult or emotional customer situations; Responds promptly to customer needs; Solicits customer feedback to improve service; Responds to requests for service and assistance; Meets commitments.
• Verbal Communication - Speaks clearly and persuasively in positive or negative situations; listens and gets clarification; Responds well to questions; Demonstrates group presentation skills; Participates in meetings.
• Written Communication - Writes clearly and informatively; Edits work for spelling and grammar; Varies writing style to meet needs; Presents numerical data effectively; Able to read and interpret written information.
• Business Acumen - Understands business implications of decisions; Displays orientation to profitability; Demonstrates knowledge of market and competition; Aligns work with strategic goals.

Physical Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this Job, the employee is regularly required to sit and talk or listen. The employee is occasionally required to stand; walk; use hands to finger, handle, or feel and reach with hands and arms. The employee must occasionally lift and/or move up to 35 pounds

Work Environment

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

The noise level in the work environment is usually moderate.

Work Location

This position works on-site at the San Diego Headquarters or other company location (or from a remote location with management approval based on business requirements). Must provide adequate support to internal clients; be available for regular interactions and coordination of work with other employees, colleagues, clients, or vendors; as well as be available to facilitate effective decisions through collaboration with stakeholders.

Working Hours

This is an exempt level position requiring the incumbent to work the hours required to fully accomplish job responsibilities and reasonable meet deadlines for work deliverables. The individual must have the flexibility to work beyond traditional hours and be able to work nights, weekends or on holidays as required. Work hours may be changed from time to time to meet the needs of the business. Typical core business hours are Monday through Friday from 8:00am to 5:00pm.

Travel

This position may require occasional travel and attendance at local conferences and meetings.

The Perks:

• Medical / Dental / Vision / Wellness Programs
• Paid Time Off / Company Paid Holidays
• Incentive Compensation
• 401K with Company match
• Life and Disability Insurance
• Tuition Reimbursement
• Employee Referral Bonus

To explore all that MedImpact has to offer, and the greatness you can bring to our teams, please submit your resume to www.medimpact.com/careers

MedImpact, is a privately-held pharmacy benefit manager (PBM) headquartered in San Diego,
California. Our solutions and services positively influence healthcare outcomes and expenditures, improving the position of our clients in the market. MedImpact offers high-value solutions to payers, providers and consumers of healthcare in the U.S. and foreign markets.

Equal Opportunity Employer, Male/Female/Disabilities/Veterans

OSHA/ADA:

To perform this job successfully, the successful candidate must be able to perform each essential duty satisfactorily. The requirements listed are representative of the knowledge, skill, and/or ability required.
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Disclaimer:

The above
statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified.