REPORTING TO THE DIRECTOR OF CLINICAL PHARMACY, THE CLINICAL PHARMACIST II – FORMULARY MANAGEMENT IS PRIMARILY RESPONSIBLE FOR OVERSIGHT AND MANAGEMENT OF THE PLAN’S FORMULARIES FOR MEDICAID AND COMMERCIAL LINES OF BUSINESS. THE CLINICAL PHARMACIST II, UNDER THE SUPERVISION OF THE DIRECTOR IS ALSO RESPONSIBLE FOR SUPPORTING CLINICAL INITIATIVES THAT ENHANCE THE PLAN’S STRATEGIC GROWTH OBJECTIVES.
Key Functions/Responsibilities:
- Participate in the development of formulary management strategies related to specific drug coverage, step therapy protocols, quantity limits, and prior authorization guidelines
- Recommend strategic placement of existing or new drugs on the formulary to maximize benefits based on market trends, rebate opportunities and or clinical guidelines.
- Produce and analyze pharmacy cost trends and support pharmacy benefit design in collaboration with finance and actuarial teams and the PBM partner.
- Annually review Authorization criteria, Quantity limits and formularies to ensure they meet all NCQA/regulatory guidance on both the Medical and Pharmacy Benefits for each line of business.
- Act as a resource for drug information and Pharmacy business support for key internal and external stakeholders
- Review existing clinical policies and ensure clinical practice guideline changes s are
- Coordinate the activities of the Plan’s Pharmacy and Therapeutics Committee including clinical and financial reviews of individual drugs, drug classes, formulary development, and development of clinical policies and related
- Assist with clinical pharmacy reporting related to Plan’s contractual
- Ensure all pharmacy management programs meet applicable NCQA, state and/or contractual utilization management (UM)
- Ensure that plan formulary is consistent with current standards of quality medical care and medical
- Present strategies to decrease pharmacy costs to ACO partners and assist in provider detailing strategies to successfully implement recommentations.
- Leads effort in marketing and pharmacy-related member and provider communication materials.
- Assist in the development and maintenance of quality improvement projects, quality metrics, and quality outcome measurements
- Work with internal and external staff to ensure accurate implementation of the Plan’s formularies in accordance with regulatory and/or contractual requirements
- Responsible for ensuring that the Plan’s website is current and accurate including prior authorization criteria, formulary, links, explanations for how to file a request for coverage, etc.
- Other activities as necessary to support utilization management
- Regular and reliable attendance is an essential function of the
Qualifications:
Education Required:
Experience:
- 3+ years of prior managed care
- Pharmacy & Therapeutics Committee experience
- 5+ years of prior managed care experience preferred
- Current unrestricted licensure as a pharmacist in any U.S. state or territory required
COMPETENCIES, SKILLS, AND ATTRIBUTES:
- Extensive knowledge of drug products, medical therapeutics, pharmacokinetics, and disease
- Strong oral and written communication skills; ability to interact within all levels of the organization as well as with external
- Strong presentation skills and experience with MS PowerPoint
- Demonstrated strong organization and time management
- Able to work in a fast paced environment; ability to multi-task.
- Experience with standard Microsoft Office applications, particularly MS Outlook and MS Word, MS Excel, and other data entry processing
- Strong analytical and clinical problem solving
WORKING CONDITIONS AND PHYSICAL EFFORT:
- Work is normally performed in a typical interior/office work environment.
- No or very limited physical effort required. No or very limited exposure to physical risk.
- Occasional travel (<5%)
Required Skills
Required Experience