Manager, Formulary Administration - San Diego, United States - MedImpact Healthcare Systems

Description

Manager, Formulary Administration & Strategy

$110,714 - $155,000 - $199,286

"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

The Scoop:

The Manager, Formulary Administration & Strategy is responsible for managing operational and strategic initiatives and projects, focuses on the development of programs and processes for formularies across all lines of business (Medicare, Medicaid, Commercial, and Health Insurance Exchange). This position plans and manages day-to-day activities of self and staff and continually monitors performance against department and company goals.

What You Get To Do:

• Provides clinical, operational, supervisory guidance, and oversight to formulary administration and strategy staff
• Develops formulary strategy and recommendations such as drug and UM positioning (e.g. quantity limit, step therapy, and/or prior authorization) in response to newly approved therapeutic agents, patent expirations, FDA alerts and drug recalls or withdrawals for Standard MedImpact formularies
• Provides internal and external support for Proposals, Implementations, Audits and Sales
• Attends RFP Kickoff, Sales Optimization, Conception Forum, Implementation and Best and Final meetings if needed to provide consultation for onboarding a client
• Performs intake assessment and quality review of formulary work product prior to implementation and client distribution
• Manages and supports inter and intra-departmental and external inquiries and requests surrounding the past plan year audits, the current plan year maintenance and the future plan year build concurrently
• Reviews new drug categorization changes to customize, implement, and integrate with MedImpact formulary product as appropriate
• Monitors drug vendor and regulatory bodies for operational or strategic market changes
• Strategizes in collaboration with Industry Relations and Health Services to build pre-plan year formularies as well as maintaining current plan year formularies
• Integrates clinical, operational and CMS/States guidance expertise and perspective
• Serves as Formulary representative on MedImpact Pharmacy and Therapeutics Committee, attends Formulary Committee meetings as a voting member
• 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
• Collaborates with MedImpact's Government Program Services, Drug Information, Prior Authorization, Configuration Services, Rebates, Clinical Analytics, and Clinical Consulting teams to ensure accurate, cost-effective and up-to-date formulary content
• Manages negative formulary change process compliant to CMS/States guidance for MedImpact Standard formularies
• Provides formulary-specific documentation of maintenance activities to clients and regulatory bodies as appropriate
• Ensures that policies and procedures and job aids are documented and followed
• Manages, contributes to, and assists with current priority projects, programs, or initiatives as defined by leadership
• Coordinates inter- and intradepartmental project activities and groups as necessary to meet project goals and timeframes
• Promotes rational and appropriate drug use in the Medicare population
• Provides direct client clinical consultation relative to formulary drug placement, appropriate utilization management edits and related client specific web documents for Step Therapy and Prior Authorization Guidelines required by CMS/States
• Provides direct client consultation on CMS/States statutory regulations and CMS/States issued regulatory guidance to ensure continued CMS/States formulary approval
• 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 operations, programs, and software
• Responsible for accurate and timely task estimation and status reporting to Director, Formulary Administration & Strategy
• Executes within the confines and timeframes provided by CMS/States which may include non-standard business hours

Supervisory Responsibilities

• Directly supervises assigned staff in the Formulary Administration & Strategy department
• Carries out supervisory responsibilities in accordance with the organization's policies and applicable laws
• Responsibilities include interviewing, hiring, and training employees; planning, assigning, and directing work; appraising performance; rewarding and disciplining employees; addressing complaints and resolving problems

Education and/or Experience

For consideration candidates will need:

• Pharm D. from an accredited school of pharmacy
• Five (5) to seven (7) years' related experience and/or training; or equivalent combination of education and experience
• Leadership experience may be substituted with four (4) years of MedImpact experience plus an appropriate external leadership training program and internal mentorship with a seasoned leader (Dir ) for current active employees

Computer Skills

To perform this job successfully, the individual should have knowledge of Microsoft Office Suite Word Processing software.

Certificates, Licenses, Registrations

Valid Registered Pharmacist license in the State of California or equivalent state.

Other Skills and Abilities

• Prior experience in PBM formulary setup and maintenance, relational and analytical database management programs, as well as, familiarity with First DataBank, Medi-Span and RxNorm drug files preferred
• Prior experience with Medicare Part D, Medicaid, Health Insurance Exchange and/or Commercial formulary development and maintenance processes highly desirable
• Must be able to execute and deliver within the confines and timeframes provided by CMS/States which may include non-standard business hours
• Prior management experience preferred.

Travel

This position requires no travel; however, attendance may be required at various local conferences and meetings.

The Perks:

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

This position is eligible for Employee Referral Bonus at Level II

To explore all that MedImpact has to offer, and the greatness you can bring to our teams, please submit your resume to

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.