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Medicare Part D Formulary Manager
2 months ago
Excellus Health Plan Inc. is seeking a highly skilled Medicare Part D Formulary Manager to join our team. As a key member of our organization, you will be responsible for creating and executing the Medicare Part D formulary, ensuring the longevity of our Part D program and delivering value to our enrollees.
Key Responsibilities- Develop and maintain the Part D formulary in collaboration with strategic business partners to maximize savings, ensure quality, and minimize member disruption.
- Manage all CMS Part D Formulary requirements to ensure deadlines are met, working in conjunction with the vendor Pharmacy Benefit Manager (PBM) and Formulary Management vendor.
- Collaborate with cross-functional management teams to align and prioritize Medicare objectives across the organization, ensuring success within the framework of the Medicare STARS ranking system.
- Obtain endorsement of the Medicare Part D formulary program elements from the Pharmacy and Therapeutics Committee.
- Oversee the production of CMS formulary model materials in partnership with Medicare Sales and Marketing, working in conjunction with outside vendors as needed.
- Support and educate inter-departmental staff and external customers on Part D formulary, utilization management edits, and CMS Part D program guidance.
- Review, formulate, and execute corrective action plans in conjunction with Medicare Compliance for all formulary-based findings.
- Support and act as subject matter expert for CMS formulary-based audits.
- Pharmacy Degree and NY State Licensure required with a minimum of three years' experience in an organized health care setting or in a practice environment with direct physician interaction, clinical practice, data analysis, and/or benefit interpretation process experience.
- Expertise and background with Federal and state regulatory agencies (CMS, DOH, DFS, etc.) and/or accreditation agencies (NCQA, BCBSA) is preferred, but not required.
- Experience in Medicare Part D is strongly preferred.
- Ability to serve as a professional, articulate, and knowledgeable liaison regarding pharmacy benefits both externally and internally.
- Excellent project management skills, including the ability to manage multiple complex projects within time and budget constraints.
- Strong problem-solving ability, coordinates, directs, and leads coworkers, recognizes problems using scientific and logical thinking, and evaluates solutions.
- Exercises good judgment and maintains composure and professional demeanor in the face of high stress situations.
- Excellent analytical and business planning skills.
- Excellent written and oral communication skills.
- Ability to deal professionally with all levels of staff and management.
- Capable of working independently and applying problem-solving and analytical abilities to situations where no precedent exists.
Excellus Health Plan Inc. aims to attract the best talent from diverse socioeconomic, cultural, and experiential backgrounds to diversify our workforce and best reflect the communities we serve. We believe that diversity of thought and background drives innovation, enabling us to provide leading-edge healthcare insurance and services.
Equal Opportunity EmployerExcellus Health Plan Inc. is an equal opportunity employer and welcomes applications from diverse candidates. We are committed to creating an inclusive work environment that values diversity, equity, and inclusion.
