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Capital Rx · 1 week ago

Formulary Operations Manager - Exchange

United States

Full-time

Remote

Entry, Mid Level

$135K/yr - $145K/yr

2+ years exp

Judi Health is an enterprise health technology company providing a comprehensive suite of solutions for employers and health plans. The Formulary Operations Manager is responsible for operational support in the evaluation, implementation, and maintenance of formularies and utilization management, requiring strong collaboration and communication skills.

Hospital & Health Care

Responsibilities

Define, configure, and maintain standard and custom formularies for the Commercial and Health Information Marketplace/Exchange lines of business

Provide client-facing strategic and operational support for the configuration, implementation, maintenance, and quality control of custom formularies, drug lists, custom formulary marketing materials, clinical adjudication lists, and utilization management edits

Evaluate appropriateness and operationalize custom client formulary and benefit requests within the formulary / adjudication platform

Collaborates with teams in a cross-functional environment including, but not limited to; benefit administration, rebate administration, client account management, analytics, software development/product, regulatory/compliance, government programs, member experience, prior authorization operations, and marketing

Develop weekly drug product review and formulary recommendations by assessing drug use trends, new drug releases, and review of primary literature

Analyze pharmacy cost of care, clinical updates, and coordinate the development of appropriate formulary management programs and utilization management edits

Set criteria for medication analysis and coordinate methodology for client requested and regulatory formulary reporting requirements

Evaluate drugs/drug classes and make formulary positioning and utilization management recommendations and formulary management strategies and associated adjudication requirements to operationalize

Provide cross functional support for claim troubleshooting within the adjudication platform

Support comprehensive testing of client formulary and benefit elections

Support formulary change processes within URAC/NCQA/SOC guidelines and requirements

Support client formulary requests, as required

Support quality improvement projects, as required

Support the Capital Rx pharmaceutical pipeline, as needed

Support Request for Information (RFI) and Request for Proposal (RFP) submissions, as needed

Support general business needs and operations, as required

Responsible for adherence to the Capital Rx Code of Conduct including reporting of noncompliance

Qualification

Doctor of Pharmacy (PharmD)Registered pharmacist licenseFormulary experienceMedicare experienceFormulary development knowledgeSpecialty medications knowledgeRebate implications knowledgeLarge datasets experienceMicrosoft Excel proficiencyCross-functional collaborationCommunication skillsAttention to detail