MedImpact Healthcare Systems, Inc.
Receive alerts when this company posts new jobs.
Formulary Administration Pharmacist
at MedImpact Healthcare Systems, Inc.
San Diego, CA
# of openings:
Added to system:
12/5/18 4:37 PM
Formulary Administration Pharmacist
If you’re interested in a career within a customer-focused, team-oriented environment that rewards innovation, quality, integrity and collaboration, MedImpact Healthcare Systems, Inc. welcomes your application. 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.
The Formulary Administration Pharmacist manages operational aspects of business unit, department, and strategic initiatives, projects, and/or programs. This position focuses on efforts of the MedImpact Formulary Administration & Strategy Team in quality control and analysis of MedImpact 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.
Essential Duties and Responsibilities include the following. Other duties may be assigned.
- 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. Medicare Part D, Medicaid, Commercial, and Health Insurance Exchange).
- Supports Medicare Part D formulary administration as follows:
- 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 documents for Step Therapy and Prior Authorization Guidelines required by CMS/States. Provides direct client consultation on;
- All formulary maintenance operations, programs, software, CMS/States statutory regulations, and CMS/States issued regulatory guidance to ensure continued CMS/States formulary approval.
- Coordinates quality control and analytics related to MedImpact Standard and Custom formulary changes including appropriate formulary content, application of utilization management activities, printed formularies, Plan Finder formulary files and other 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 compliance with regulatory requirements for all formularies.
- Supports MedImpact Standard and Custom formulary print functions in accordance with CMS/States regulatory statute and guidance. Reviews new drug categorization changes to customize, implement, and integrate with MedImpact printed formulary products as appropriate.
- Provides formulary-specific documentation of maintenance activities to clients and regulatory bodies as appropriate.
- Collaborates with Government Program Services (GPS) to provide Explanation of Benefits formulary changes to Medicare Part D formulary clients as appropriate.
- 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.
- Provides internal and external support for Proposals, Implementations, Audits and Sales. Attends RFP Kickoff, Sales Optimization, Conception Forum, Implementation and Best and Final meetings.
- 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 Committee: 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.
- 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.
- Must be able to learn cross functional operations within the department to allow ability to support colleague managers in a range of accountabilities. Must be able to function with flexibility in a changing business and government regulated environment.
Education and/or Experience
For consideration, candidates will need a Doctorate of Pharmacy from an accredited school of pharmacy; three (3) to five (5) years job related experience and/or training; or equivalent combination of education and job related experience.
To perform this job successfully, an individual should have knowledge of Microsoft Office Suite and a working knowledge of relational databases.
Certificates, Licenses, Registrations
Registered Pharmacist in the State of California or equivalent state
Other Skills and Abilities
- Prior experience in PBM/Benefits Services formulary setup and maintenance, relational and analytical database management programs, as well as, familiarity with First DataBank and/or Medispan drug files desirable
- Prior experience with Medicare Part D, Medicaid, Marketplace and/or Commercial formulary development and maintenance processes desirable
- Must be able to execute and deliver within the confines and timeframes provided by CMS which may include non-standard business hours
This position is eligible for Employee Referral Bonus at Level II
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.
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.