Clinical Formulary Pharmacist

Clinical Formulary Pharmacist page is loaded## Clinical Formulary Pharmacist locations:
Long Beach Office 3800time type:
Full time posted on:
Posted Yesterday job requisition :
JR2074
** SCAN Group is a not-for-profit organization dedicated to tackling the most pressing issues facing older adults in the United States. SCAN Group is the sole corporate member of SCAN Health Plan, one of the nation’s leading not-for-profit Medicare Advantage plans, serving more than 277,000 members in California, Arizona, Nevada, Texas and New Mexico. SCAN has been a mission-driven organization dedicated to keeping seniors healthy and independent for more than 45 years and is known throughout the healthcare industry and nationally as a leading expert in senior healthcare.
**** SCAN employees are a group of talented, passionate professionals who are committed to supporting older adults on their aging journey, while also innovating healthcare for seniors everywhere. Employees are provided in-depth training and access to state-of-the-art tools necessary to do their jobs, as well as development and growth opportunities. SCAN takes great pride in recognizing our team members as experts in their fields and rewarding them for their efforts.

If you are interested in becoming part of an organization that is innovating senior healthcare visit (Use the "Apply for this Job" box below). , or follow us on Linked In, Facebook, and Twitter.
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* Job Description:

** The Job
** The
** Clinical Formulary Pharmacist
** will play an important role in providing operational support for evaluation, implementation, and maintenance of Medicare Part D Formulary and Utilization Management, review of new drugs with the Pharmacy & Therapeutics Subcommittee/Committee. This position is accountable for ensuring regulatory compliance with respect to the Medicare Part D formulary submissions to CMS, pharmacy benefits, formulary and transition program implementation with PBM, website content for all business lines, pharmacy ne work and CMS’s Part D regulatory audits.

The
** Clinical Formulary Pharmacist
** stays abreast of pharmacy, PBM, payer industry changes, pipeline, drug trends, best practices, and CMS’s rules and regulations, including Inflation Reduction Act. The role requires strong cross functional collaboration and communication skills, and an understanding of Medicate Part D formulary and Utilization Management (UM) processes.
** You Will
*** Ensures regulatory compliance with P&T operations, Formulary & Benefit Administration, Transition Programs, annual Part D bid submission process, pharmacy-related member and other stakeholders’ communications and marketing materials, including member formulary drug list, website content, trainings, pharmacy network and CMS’s regulatory audits.
* Produces, maintains, and implements Part D Formulary, Prior Authorization criteria, Step Therapy criteria, Supplemental files, and clinical rules in accordance with CMS requirements on monthly and annual basis and submits these files to CMS.
* Develops and maintains formulary exception criteria.
* Evaluates and reviews new drugs/biosimilar with the Pharmacy & Therapeutics
* Subcommittee/Committee within 90-180 days of being marketed and makes Formulary and UM recommendations based on the clinical appropriateness, cost analysis and CMS guidelines.
* Works in collaboration with Medical Directors to evaluate and analyze treatment protocols and procedures related to the SCAN Health Plan formulary, at least annually.
* Provides CMS Part D regulatory audit support for respective areas.
* Produces member communications and marketing materials, within internally determined time frames, with accuracy and in accordance with CMS marketing guidelines. Partners with Marketing, Compliance and Member Services and vendors, as needed. Prepares training materials.
* Maintains on-line comprehensive formulary on a monthly basis on accordance with CMS requirements.
* Assists with Formulary and UM modeling for the annual Formulary and BID submissions to CMS. Reviews accuracy of the Formulary, UM files, and Pharmacy Benefits for the annual BID submission to CMS.
* Prepares Formulary/Pharmacy Benefits Industry Analysis…