Formulary Administration Pharmacist
7 days ago
Job Description
HealthPartners is hiring Formulary Administration Consultant.
This position is responsible for the formulary management of Regulated Products (Medicare, State Public Programs, Exchange, and Federal Employees Programs).
The consultant will assist in the development, maintenance, and communication of all formularies and covered products.Areas of focus include Regulated Products formulary and benefits; Fraud, Waste and Abuse (FWA) Management, Marketing and Member Materials, Compliance and Audit Support.
The position also supports Pharmacy Department initiatives.MINIMUM QUALIFICATIONS:
Education, Experience or
Equivalent Combination: Minimum of two years of experience working in a managed care pharmacy or clinical pharmacy setting or completion of a managed care pharmacy residency program
Licensure/ Registration/ Certification:
Licensed Pharmacist in Minnesota
Knowledge, Skills, and Abilities:
Familiar with formulary maintenance. Familiar with the development of drug coverage policies and utilization management programs. Demonstrated skill in problem solving, planning, organizing and time management. Demonstrated skill in effective project management including use of project planning and tracing tools, achievable goals, objectives, and timelines, and innovative use of resources. Excellent verbal and written communication skills. Excellent attention to detail and accuracy. Ability to manage multiple projects simultaneously. Ability to solve problems with minimal direction. Self-motivated with critical thinking ability and ability to work independently. Must be able to establish and maintain effective, courteous, and confidential relationships with coworkers, staff, employer groups, and members.
PREFERRED QUALIFICATIONS:
Knowledge, Skills, and Abilities:
Pharmacy Benefit Management experience including formulary and utilization management experience. Medicare Part D experience. Health Insurance Exchange experience. Experience with Minnesota State Public Programs (e.g., Medicaid)
Essential Duties: 1. Leads and carries out activities related to the annual development and submission of formularies for Exchange, State Public Programs and/or Medicare lines of business. 2. Serves as the Pharmacy formulary subject matter expert and advisor for a specific product line. 3. Reviews new drugs to the market and recommends specific formulary and UM assignments. 4. Works with actuary team to develop market competitive and member friendly formulary. 5. Tracks coverage change decisions made by the Pharmacy & Therapeutics Committee and ensures changes are implemented in accordance with internal business rules and statutory and regulatory requirements. 6. Supports clinical program updates. 7. Understands drug product information to support oversight and monitoring of PBM activities. 8. Assists with communications to both members and providers who are affected by drug coverage changes. 9. Assists other pharmacy personnel (such as Formulary Administration Coordinators and Configuration Services Analysts) in all other areas of formulary and benefit maintenance as needed. 10. Maintains a thorough and comprehensive understanding of state and federal requirements (statutory and regulatory) and accreditation standards (Commercial, Exchange, State Public Programs, and/or Medicare). 11. When problems are identified, assists with corrective action plan documentation and issue resolution. 12. Reviews written department materials and policies and procedures, revising them as needed to provide uniformity and usability. 13. Supports regulatory and accreditation audits including formulary and benefit related questions and submission of documentation as needed. 14. Supports decision trees development and maintenance. 15. Assists in development and management of unique pharmacy coverage programs and product offerings. 16. Works with the HealthPartners PBM through data analytics to identify pharmacy substantiated or suspicious activities of FWA. 17. Uses medical and pharmacy claims data to identify outlier prescribers of opioids with unusually high volume and dosages. Works with provider contracting to determine appropriate prescribing practices. 18. Analyzes CMS-provided FWA drug tend reports and proposes appropriate actions.
About Us
At HealthPartners we believe in the power of good - good deeds and good people working together.
As part of our team, you'll find an inclusive environment that encourages new ways of thinking, celebrates differences, and recognizes hard work.
We're a nonprofit, integrated health care organization, providing health insurance in six states and high-quality care at more than 90 locations, including hospitals and clinics in Minnesota and Wisconsin.
We bring together research and education through HealthPartners Institute, training medical professionals across the region and conducting innovative research that improve lives around the world.
At HealthPartners, everyone is welcome, included and valued.We're working together to increase diversity and inclusion in our workplace, advance health equity in care and coverage, and partner with the community as advocates for change.
Join us and become a partner for good, helping to improve the health and well-being of our patients, members and the communities we serve.
We are an Equal Opportunity Employer and do not discriminate against any employee or applicant because of race, color, sex, age, national origin, religion, sexual orientation, gender identify, status as a veteran and basis of disability or any other federal, state or local protected class.
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