Clinical Formulary Specialist

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Full Time Montvale, NJ, US

Job Description

Clinical Formulary Specialist

Empi Rx Health is the leading clinically-driven pharmacy benefits management company. As the pioneer in value-based pharmacy care, Empi Rx Health puts its customers and members first by enabling them to take control of their pharmacy benefits, healthcare outcomes, and financial results.

We place more emphasis on member care than any other PBM by focusing on health outcomes first. Our pharmacists and clinicians are at the center of everything we do - and our population health solution delivers tailored strategies for our clients. Leveraging our newly launched, AI-powered pharmacy care platform, Clinically ™, Empi Rx Health’s pharmacists and client experience teams provide the highest quality pharmacy care to our clients and their members.

This enables benefits plan sponsors to keep their members healthy, happy, and productive, while substantially reducing prescription drug spending, which has been on an explosive growth trajectory in recent years.

The Clinical Formulary Specialist is a pharmacist who works with and supports the Senior Manager, Formulary Strategy to ensure Empi Rx Health achieves deep and sustainable savings guaranteed to our clients, while maintaining clinically appropriate pharmacy care. This role collaborates with internal partners to ensure the accuracy, maintenance, and execution of Empi Rx Health Formularies, Clinical Program Edits, and Drug Lists.

Externally, the Clinical Formulary Specialist serves as a Subject Matter Expert (SME), providing critical clinical expertise and guidance to support the Empi Rx Health Sales Team across all sales opportunities.

Key Responsibilities:

Formulary and Clinical Program Edit Management

• Support Senior Manager of Formulary Strategy to ensure formulary strategies are implemented appropriately.
• Assist in preparing quarterly P&T Committee submissions for formulary, clinical program edit changes and clinical review policies/protocols.
• Closely monitor the drug pipeline for new brand, biosimilar, generic, and indications, and review formulary placement, new to market block and clinical edit needs.
• Act as a point of contact for the P&T Committee reviews for all internal teams through the final approval, meeting participation and post-meeting decision documents review.
• Assist with Clinical Review Policy/Protocol updates, revisions and translation into electronic PA (ePA) on an ongoing basis.
• Review quarterly P&T Committee changes and member impacts that are shared with Client Management for client and advisor notification.
• Collaborate with necessary parties to ensure production of client-facing formularies.

Clinical Services

• Collaborate with Clinical Account Executives in the creation, maintenance, and cataloguing of customized Drug Lists.
• Coordinate the quarterly Population Health Dashboard campaigns with Analytics, IT, and Client Management and assist with relevant inquiries.
• Actively participate in the pharmacy benefits sales process, including sales strategy meetings, providing clinical expertise to the team.
• Provide recommendations to the Proposals team for clinical programs and formularies.
• Review and approve Clinical Efficiency Assessments for RFP/RFI submissions.
• Act as a subject matter expert on the Sales Team, participating in sales meetings with advisors and prospects as requested.
• Effectively support, advise, and answer clinical questions for RFP/RFI submissions as requested.
• Collaborate with cross-functional teams to build consensus among departments while supporting the clinical aspects of overall sales initiatives.
• Participate in finalist meeting presentations as requested.

Tools & Reporting

• Proficiently utilize and become a super-user of Empi Rx Health Clinical tools (e.g., Clinical Efficiency Assessment Tool, RxCurve 360, and Clinical Savings Tracker).
• Assist in enhancements needed for Empi Rx Health Clinical tools as well as participate in new clinical tool development as assigned (e.g., testing, validating, etc.).
• Proficiently utilize third-party platforms and reporting tools needed for successful management of patient cases and clients (e.g., SharePoint, Formulary Navigator, etc.).
• Utilize Empi Rx Health applications for data access and information exchange and tracking with other departments (e.g., Salesforce, DOMO,…