Formulary Administration Pharmacist

Exemption Status

United States of America (Non-Exempt)

$52.17 - $73.30 - $94.43

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.

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 the efforts of the Sav Rx powered by Med Impact Formulary Administration Team in quality control and analysis of Med Impact 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.

• 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. Medicaid, Commercial, and Health Insurance Exchange).
• 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.
  • Manages formulary activities related to Med Impact 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.
  • 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/Manager, Formulary Administration & Strategy.
  • Provides formulary‑specific documentation of maintenance activities to clients and regulatory bodies as appropriate.
  • 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.

No supervisory…