Manager Formulary Design and Strategy

Job Summary:

The Manager, Formulary Design & Strategy leads the creation of formulary design best practices and industry-leading, market-competitive formulary management strategies across all CareSource lines of business and markets.

Essential Functions:

• Manages the CareSource RXInnovations Value Assessment Committee including preparation of meeting materials and presentations, and education of stakeholders following committee meetings
• Directs and ensures the efficient operational management of the formulary management team with emphasis on execution, outcomes, continual improvement and performance enhancement
• Oversees the monitoring of and educates stakeholders on the drug development pipeline and strategies we will employ to appropriately manage new and existing drugs
• Works with appropriate business partners to ensure accurate and timely implementation of formulary changes by PBM
• Monitors the formulary change process to minimize member disruption but drive value and better member outcomes
• Supports leadership in direct rebating decisions and negotiations in collaboration with pharmaceutical manufacturers
• Creates, monitors, and reports monthly on key performance indicators (KPIs) related to formulary management, including but not limited to cost and member, provider and/or drug utilization
• Ensures team collaboration with Clinical Program Mangers to create and improve programs that drive better member health outcomes
• Leads the identification, quantification and measurement of total cost of care savings opportunities related to formulary management and other drug management techniques
• Collaborates with other teams to communicate and educate members, providers, pharmacies, and internal business partners on formulary, prior authorizations, specialty drugs and other initiatives
• Ensures regulatory and compliance guidelines are met for Medicaid, Medicare, Exchange and future lines of related to formulary management and the development of clinical policies and criteria
• Develops policies, trainings, and procedures to ensure compliance with new and existing regulations and accreditation standards.
• Analyzes data regularly to identify process improvement opportunities relating to formulary management, as well as clinical policy and criteria development
• Accountable for motivating, hiring, training, coaching, professional development, succession planning, performance appraisals, and disciplinary actions of staff
• Advises and precepts APPE students and residents
• Participates in department and team initiatives and projects
• Participates in relevant pharmacy research projects and educational programs
• Perform any other job duties as requested

Education and Experience:

• Bachelor’s Degree in Pharmacy or Pharmacy Degree (PharmD) required; Master’s in Business Administration or related is preferred
• Minimum of five (5) years of managed care experience required, to include minimum of two (2) years of formulary management experience
• Experience participating in or leading a P&T, Value Assessment Committee, or Drug Utilization Review Board required
• Previous management experience is required
• Experience working with multiple lines of business (commercial or government lines of business (Medicare, Medicare, or Marketplace)) or multiple states is preferred
• Experience with state-mandated formularies preferred

Competencies, Knowledge and Skills:

• Proficiency in Microsoft Word and Outlook and advanced proficiency in PowerPoint and Excel
• Strong presentation skills and ability to interact effectively with internal/external audiences, summarize work for different audiences
• Strong problem solving skills
• Familiarity with medical terminology
• Extraordinary attention to detail
• Ability to synthesize large amounts of findings orally and in writing
• Excellent time management and ability to effectively, efficiently and accurately manage multiple tasks simultaneously under tight timelines in a fast-paced healthcare environment
• Proven track record of creative or “out of the box” thinking
• Ability to work independently and within a team environment
• Strong oral, written, and interpersonal communication skills
• Excellent leadership, management and supervisory skills
• Energetic, enthusiastic, and politically astute
• Ability to act with diplomacy and sensitivity to cultural diversity
• Responsive to a changing environment
• Strategic management skills
• Conflict resolution skills
• Strong decision making skills
• Customer service skills with the ability to interact professionally and effectively with members, providers, internal business areas and colleagues
• Strong analytical skills with the ability to create reports and interpret operational, utilization and financial data
• Proven problem-solving skills with the ability to look for root causes and develop implementable, workable solutions

Licensure and Certification:

• Unrestricted registered pharmacist (RPh) Licensure is required

Working Conditions:

• General office environment; may be required to sit or stand for extended periods of time

Compensation Range:

CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.

Compensation Type (hourly/salary):

Organization Level Competencies

• Create an Inclusive Environment

• Cultivate Partnerships

• Develop Self and Others

• Drive Execution

• Influence Others

• Pursue Personal Excellence

• Understand the Business

This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an inclusive environment that welcomes and supports individuals of all backgrounds.