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Role Description

This role involves managing formulary and utilization strategies, data analysis, and collaboration with internal and external stakeholders.

• Formulary & Utilization Management
  • Strategy Development: Design clinically sound UM tools and client-specific solutions to support cost-effective formulary structures.
  • Maintenance & QA: Maintain the accuracy of drug formularies across all platforms through rigorous testing and quality assurance.
  • Clinical & Financial Review: Evaluate new drug products and drug classes to recommend positioning based on rebate compliance, market trends, and clinical evidence.
• Data Analysis & Insights
  • Claims Analysis: Audit claims data to identify cost-savings opportunities and trends that require clinical intervention.
  • Strategic Optimization: Translate data into actionable insights to enhance formulary performance and reduce healthcare costs.
• Pipeline & P&T Committee Support
  • Pipeline Evaluation: Monitor and assess the potential formulary impact of upcoming drug pipelines.
  • Committee Coordination: Lead activities for the Pharmacy & Therapeutics (P&T) committee, including preparing drug reviews and executing formulary updates.
• Collaboration & Communication
  • Internal SME: Act as the primary clinical expert for internal operations, implementation teams, and external partners.
  • Content Creation: Develop and update clinical marketing materials and formulary communications for diverse stakeholders.

Qualifications

• Doctor of Pharmacy (PharmD) required.
• Minimum of 2 years in managed care or PBM (with a focus on formulary/operations) OR completion of a managed care residency.
• Proven knowledge of pharmacy benefit management (PBM) practices, including UM and clinical program design.
• Expertise in Medispan drug file systems and advanced MS Office skills (specifically Excel and Access).
• Ability to prioritize multiple high-stakes tasks in a fast-paced, evolving corporate environment.
• Exceptional interpersonal, written, and verbal communication skills.
• Strong critical thinking skills with the ability to exercise independent judgment when solving complex problems.

Benefits

• Highly competitive wellness benefits including Medical, Pharmacy, Dental, Vision, and Life Insurance and AD&D Insurance.
• Flexible Spending Benefits.
• 401(k) Retirement Savings Program.
• Short-term and long-term disability.
• Discretionary Paid Time Off.
• Paid Company Holidays.
• Wellness Benefits.
• Commuter Benefits.
• Paid Parental Leave benefits.
• Employee Assistance Program (EAP).
• Well-stocked kitchen in office locations.
• Professional development and training opportunities.