Job description
Job Summary:
The Pharmacist – Formulary Strategy and Management researches and develops moderate to complex industry-leading medical and pharmaceutical formularies, criteria, and drug policies that are cost effective and drive best clinical practice.
Essential Functions:
- Perform competitive analysis on our market and line of business formularies to identify opportunities to enhance our formularies
- Develop prior authorization and step therapy criteria and other utilization management edits
- Develop formulary monitoring and reporting tools to ensure appropriate utilization and cost effectiveness of formulary design
- Prepare SERFF and JSON files for submission
- Complete regulatory and market requests as assigned
- Ensure regulatory requirements and submission deadlines are met
- Ensure adherence to company, state, and federal guidelines
- Research clinical and scientific literature and consensus guidelines to create work products for team input
- Support the operational processes of the Pharmacy and Therapeutics, Value Assessment, and Clinical Policy committees and other applicable committees
- Evaluate formulary changes for access to care issues and impact to operational aspects of business
- Support the development and implementation of policies and procedures
- Participate in department initiatives and projects, including relevant pharmacy research projects and educational programs
- Work with health plan business product leaders, specialty companies, and corporate leaders to develop deliverables on pharmacy priorities
- Coordinate with subject matter experts to develop policy positions on issues that impact CareSource from medical and pharmacy criteria and policy perspectives
- Advise and precept APPE students and residents
- Work with business product owners, government relations, and compliance leads to monitor legislative and regulatory activities for potential impact on existing or proposed criteria and policies
- Collaborate with interdisciplinary team members to achieve goals
- Perform any other job-related functions as requested
Education and Experience:
- Bachelors of Science in Pharmacy or PharmD is required
- A minimum of three (3) years of formulary pharmacy experience is required
- Two (2) years of previous health plan or PBM experience strongly preferred
Competencies, Knowledge and Skills:
- Demonstrated advanced computer skills/proficiency with Microsoft Word, Excel, search engines, and bibliographic software
- Knowledge of medical terminology and claims payment policies
- Strong clinical expertise and healthcare administration understanding
- Advanced analytical skills, with the ability to interpret and synthesize complex healthcare literature
- Ability to interpret complex clinical information and apply to policy development
- Excellent verbal and written communications skills
- Excellent presentation and decision-making skills
- Excellent organization and tracking skills
- Excellent problem solving skills
- Ability to interface and collaborate with employees at all levels
- Ability to handle multiple priorities/projects simultaneously
Licensure and Certification:
- Current, unrestricted Registered Pharmacist (RPh) licensure in state of practice is required
Working Conditions:
- General office environment; may be required to sit or stand for extended periods of time
- Occasional virtual office opportunity
Organization Level Competencies
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Leveraging Feedback
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Customer Orientation
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Valuing Differences
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Managing Work
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Earning Trust
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Quality Orientation
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Adaptability
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Influencing
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Collaborating
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, including disability and veteran status. We are committed to a diverse and inclusive work environment.
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