This job listing has expired and the position may no longer be open for hire.

Senior Formulary Specialist at Emblem Health in Farmington, Connecticut

Posted in General Business 30+ days ago.

Type: Full-Time





Job Description:

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

Additional Information


  • Requisition ID: 21125





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