Summary: 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.
Responsibilities:
Evaluate and maintain formulary set-up based on clinical requirements, compliance with regulatory bodies, and P&T rules.
Manage the Pharmacy & Therapeutic Committee/Formulary Management, including Step-Protocol Review, Non-Formulary Review, Subcommittee Management (Meetings/minutes), Drug Reviews, and Updates and Drug Policies, for all medications.
Manage utilization management tools, including review and update of pharmacy and medical policies, and Criteria for Medical Necessity (CMN) reviews for all medications to ensure alignment with formulary intent.
Maintain clinical tools utilized by pharmacy services for purpose of remaining up to date and compliant with current pharmacy policies.
Serve as subject matter expert for all escalated clinical formulary related issues as well as for all formulary related internal and external audits.
Other duties/projects as assigned.
Qualifications
Doctor of Pharmacy degree or Masters in Pharmacy from an accredited school of pharmacy with clinical and drug information experience
Registered Pharmacist: New York State pharmacy license or eligible to obtain or New York State license
A minimum of 10 years of relevant experience. (P)
Residency or 5 years’ clinical experience preferred (P)
Knowledge of formulary utilization management practices (R)
Knowledge of formulary management (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)
Physical & Environmental Working Conditions:
Typical office environment, with no substantial exposure to adverse environmental conditions
May be required to sit for long periods of time
No regular contact with bodily fluids, tissues or blood borne pathogens, but potential for exposure