13 days old

Senior Formulary Specialist

EmblemHealth
New York, NY 10007
  • Job Code
    191AZ
Responsible for development and maintenance activities for formularies for one or more of 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 New York State license
  • A minimum of 10 years of relevant experience preferred
  • Residency or 5 years clinical experience preferred
  • Knowledge of formulary utilization management practices required
  • Knowledge of formulary management preferred
  • Knowledge of pharmaceuticals and disease states to provide advice and consultation to providers and members, and recommend changes to the formulary required
  • Possess research and analytical skills sufficient to provide problem resolution and consultation to providers required
  • Excellent verbal and written communication skills sufficient to prepare own correspondence and interact with members and providers in provision of advice and guidelines required

Additional Information

  • Requisition ID: 191AZ






Posted: 2019-10-31 Expires: 2019-11-29
Sponsored by:
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Sponsored by:
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Senior Formulary Specialist

EmblemHealth
New York, NY 10007

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