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Lead Formulary Specialist

Job Description

Manage the formulary development & management team.  Ensure compliant formulary filings for Medicare, Medicaid, Commercial, HIX in NY and CT. Responsible for development and maintenance activities for formularies on the following lines of business: Medicare Part D, Medicaid, Commercial, Healthcare Exchange. Use sound clinical judgment and knowledge of State and Federal regulations to ensure compliance with regulatory and contractual obligations. Ensure pharmacy drug policies are current, accurate and approved by the Pharmacy & Therapeutics Committee. Assist the Vice Chair of the P&T Committee in administering the P&T Committee requirements including gathering, reviewing and sharing all meeting materials for each quarterly meeting. Partner with PBM Clinical Account Executives to identify formulary improvement opportunities quarterly.  Ensure weekly drug changes are recorded and implemented accordingly.

Responsibilities

  • Manage the day to day functions of the Sr. Clinical Pharmacy Specialists ensuring all pharmacy drug changes are implemented as required.
  • Oversee and drive pharmacy formulary strategy for the enterprise.  This entails reviewing drug trends, examining utilization management, competitor strategies, and working with internal groups (actuary, medical economics, product, and ESI) to implement formulary strategies.
  • Manage the team and the formulary calendar ensuring all state and federal submissions are timely and accurate.
  • Participate in the Pharmacy & Therapeutic Committee to include: Step-Protocol Review, Non-Formulary Review, Subcommittee Management (Meetings/minutes), Drug Reviews, and Updates.
  • Partner with the product teams to identify and implement opportunities for formulary decisions to reduce cost and increase market competitiveness. 
  • Establish strong relationships with Pharma in support of identifying rebate and cost savings opportunities.

 

 

Job Requirements

Qualifications

  • Doctor of Pharmacy degree or Masters in Pharmacy from an accredited school of pharmacy
  • Registered Pharmacist: New York State pharmacy license or eligible to obtain New York State license
  • Board certification (Pharmacotherapy, Ambulatory Care, Geriatrics, Internal Medicine, Pediatrics) preferred(P)
  • 7+years of relevant business experience (R)
  • A minimum of 2 years of management experience. (P)
  • A minimum of 5 years of pharmacist experience(R)
  • Residency or 5 years’ clinical experience preferred (P)
  • Knowledge of pharmaceuticals and disease states to provide advice and consultation to providers and members, and recommend changes to the formulary (R)
  • Possess research and analytical skills sufficient to provide problem resolution and consultation to providers (R)
  • Excellent verbal and written communication skills sufficient to prepare own correspondence and interact with members and providers in provision of advice and guidelines  (R)

Job Snapshot

Location US-NY-New York
Employment Type Full-Time
Pay Type Year
Pay Rate N/A
Store Type Health Care
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Company Overview

EmblemHealth

EmblemHealth is a local, neighborhood health plan that has served the New York City area and surrounding communities for more than 75 years. That’s the kind of experience that makes us unique. We’re proud to be one of the nation’s largest not-for-profit health plans, serving 3.1 million people who live and work across the New York tri-state area. Learn More

Contact Information

US-NY-New York
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Snapshot
EmblemHealth
Company:
US-NY-New York
Location:
Full-Time
Employment Type:
Year
Pay Type:
N/A
Pay Rate:
Health Care
Store Type:

Job Description

Manage the formulary development & management team.  Ensure compliant formulary filings for Medicare, Medicaid, Commercial, HIX in NY and CT. Responsible for development and maintenance activities for formularies on the following lines of business: Medicare Part D, Medicaid, Commercial, Healthcare Exchange. Use sound clinical judgment and knowledge of State and Federal regulations to ensure compliance with regulatory and contractual obligations. Ensure pharmacy drug policies are current, accurate and approved by the Pharmacy & Therapeutics Committee. Assist the Vice Chair of the P&T Committee in administering the P&T Committee requirements including gathering, reviewing and sharing all meeting materials for each quarterly meeting. Partner with PBM Clinical Account Executives to identify formulary improvement opportunities quarterly.  Ensure weekly drug changes are recorded and implemented accordingly.

Responsibilities

  • Manage the day to day functions of the Sr. Clinical Pharmacy Specialists ensuring all pharmacy drug changes are implemented as required.
  • Oversee and drive pharmacy formulary strategy for the enterprise.  This entails reviewing drug trends, examining utilization management, competitor strategies, and working with internal groups (actuary, medical economics, product, and ESI) to implement formulary strategies.
  • Manage the team and the formulary calendar ensuring all state and federal submissions are timely and accurate.
  • Participate in the Pharmacy & Therapeutic Committee to include: Step-Protocol Review, Non-Formulary Review, Subcommittee Management (Meetings/minutes), Drug Reviews, and Updates.
  • Partner with the product teams to identify and implement opportunities for formulary decisions to reduce cost and increase market competitiveness. 
  • Establish strong relationships with Pharma in support of identifying rebate and cost savings opportunities.

 

 

Job Requirements

Qualifications

  • Doctor of Pharmacy degree or Masters in Pharmacy from an accredited school of pharmacy
  • Registered Pharmacist: New York State pharmacy license or eligible to obtain New York State license
  • Board certification (Pharmacotherapy, Ambulatory Care, Geriatrics, Internal Medicine, Pediatrics) preferred(P)
  • 7+years of relevant business experience (R)
  • A minimum of 2 years of management experience. (P)
  • A minimum of 5 years of pharmacist experience(R)
  • Residency or 5 years’ clinical experience preferred (P)
  • Knowledge of pharmaceuticals and disease states to provide advice and consultation to providers and members, and recommend changes to the formulary (R)
  • Possess research and analytical skills sufficient to provide problem resolution and consultation to providers (R)
  • Excellent verbal and written communication skills sufficient to prepare own correspondence and interact with members and providers in provision of advice and guidelines  (R)

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Lead Formulary Specialist Apply now