Oscar Health · 1 month ago
Manager, Formulary & Medical Pharmacy Operations
United States
Full-time
Remote
Mid, Senior Level
$144K/yr - $189K/yr
4+ years expOscar is a health insurance company built around a full stack technology platform focused on serving its members. The Manager, Formulary & Medical Pharmacy Operations will oversee clinical pharmacy initiatives, manage formulary operations, and partner across departments to drive affordability savings and optimize pharmacy workflows.
Health CareHealth InsuranceInsuranceInsurTech
Responsibilities
Provide insights and recommendations for trend management and clinical effectiveness, including serving as a key contributor in the enterprise affordability process for pharmacy
Manage the pipeline of enterprise affordability projects across the pharmacy department (program operations and clinical) and oversee the performance of active initiatives
Partner with leads across the organization as necessary in order to communicate, understand and identify upstream and downstream impacts to the business
Contribute to the design and implementation of clinical programs focused on improving patient outcomes and reducing costs
These programs may include medication adherence initiatives, chronic disease management programs, and patient education efforts
Operationalize, develop and maintain a clinically appropriate and cost-effective formulary by operating and managing Oscar's P&T committee, which includes evaluating new developments in the drug treatment landscape and providing recommendations on how to manage new to market drugs and new drug indications
Oversee and optimize medical pharmacy preferred drug lists and strategies to supports utilization of lowest unit cost infusion products
Provide written recommendations with responses and corresponding documentation for regulatory inquiries, feedback on future legislation, and other business questions that probe at formulary operations
Accountable and responsible for maintaining mental health parity NQTL responses and working cross-functionally for future filings and responding to ongoing objections during the audit process
Compliance with all applicable laws and regulations
Other duties as assigned
Qualification
Required
Doctor of Pharmacy degree (PharmD)
4+ years working for PBM or Payer in clinical pharmacy operations
4+ years leading cross-functional teams/projects and change management
3+ years supporting formulary management (P&T Committee, clinical policy development, formulary run operations)
Preferred
Residency Training
Experience with Marketplace Exchange and Medicare Advantage
Benefits
Medical, dental, and vision benefits
11 paid holidays
Paid sick time
Paid parental leave
401(k) plan participation
Life and disability insurance
Paid wellness time and reimbursements
Company
Oscar Health
Oscar is a health insurance company that offers individual and family plans, medicare advantages, and small group products.
1001-5000 employees
H1B Sponsorship
Oscar Health has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (19)
2024 (24)
2023 (22)
2022 (36)
2021 (13)
Funding
Current Stage
Public CompanyTotal Funding
$1.99BKey Investors
Tiger Global ManagementAlphabetFounders Fund
2025-09-16Post Ipo Debt· $355M
2021-03-03IPO
2020-12-17Private Equity· $140M
Leadership Team
Mark Bertolini
Chief Executive Officer
Steven B. Kelmar
Executive Vice President & COS
Recent News
Sherwood News
2026-01-09
Investor's Business Daily
2025-12-18
Company data provided by crunchbase