Manager, Formulary Administration and Strategy

Exemption Status:

“Pay scale information is not necessarily reflective of actual compensation that may be earned, nor a promise of any specific pay for any selected candidate or employee, which is always dependent on actual experience, education, qualifications, and other factors.  A full review of our comprehensive pay and benefits will be discussed at the offer stage with the selected candidate.”

This position is not eligible for Sponsorship.

MedImpact Healthcare Systems, Inc. is looking for extraordinary people to join our team!

Why join MedImpact? Because our success is dependent on you; innovative professionals with top notch skills who thrive on opportunity, high performance, and teamwork. We look for individuals who want to work on a team that cares about making a difference in the value of healthcare.

At MedImpact, we deliver leading edge pharmaceutical and technology related solutions that dramatically improve the value of health care. We provide superior outcomes to those we serve through innovative products, systems, and services that provide transparency and promote choice in decision making. Our vision is to set the standard in providing solutions that optimize satisfaction, service, cost, and quality in the healthcare industry. We are the premier Pharmacy Benefits Management solution!

Job Description

Essential Duties and Responsibilities include the following. Other duties may be assigned.

• Provides clinical, operational, supervisory guidance, and oversight to formulary administration and strategy staff.
• Develops formulary strategy and recommendations such as drug and UM positioning (e.g. quantity limit, step therapy, and/or prior authorization) in response to newly approved therapeutic agents, patent expirations, FDA alerts and drug recalls or withdrawals for Standard MedImpact formularies.
• Provides internal and external support for Proposals, Implementations, Audits and Sales. Attends RFP Kickoff, Sales Optimization, Conception Forum, Implementation and Best and Final meetings if needed to provide consultation for onboarding a client
• Performs intake assessment and quality review of formulary work product prior to implementation and client distribution.
• Manages and supports inter and intra-departmental and external inquiries and requests surrounding the past plan year audits, the current plan year maintenance and the future plan year build concurrently.
• Reviews new drug categorization changes to customize, implement, and integrate with MedImpact formulary product as appropriate.  Monitors drug vendor and regulatory bodies for operational or strategic market changes.
• Strategizes in collaboration with Industry Relations and Health Services to build pre-plan year formularies as well as maintaining current plan year formularies.
• Integrates clinical, operational and CMS/States guidance expertise and perspective.  
• Serves as Formulary representative on MedImpact Pharmacy and Therapeutics Committee, attends Formulary Committee meetings as a voting member.
• Manages formulary activities related to MedImpact Standard and Custom formularies. Manages formulary change process including appropriate formulary content, application of utilization management activities, printed formularies, Plan Finder formulary files and the functions as required.  Ensures that the review, coding and quality control of formulary changes occur in an appropriate, accurate, and timely manner based on client-specific parameters.
• Collaborates with MedImpact’s Government Program Services, Drug Information, Prior Authorization, Configuration Services, Rebates, Clinical Analytics, and Clinical Consulting teams to ensure accurate, cost-effective and up-to-date formulary content.
• Manages negative formulary change process compliant to CMS/States guidance for MedImpact Standard formularies.
• Provides formulary-specific documentation of maintenance activities to clients and regulatory bodies as appropriate. Ensures that policies and procedures and job aids are documented and followed.
• Manages, contributes to, and assists with current priority projects, programs, or initiatives as defined by leadership.  Coordinates inter- and intradepartmental project activities and groups as necessary to meet project goals and timeframes.
• Promotes rational and appropriate drug use in the Medicare population. Provides direct client clinical consultation relative to formulary drug placement, appropriate utilization management edits and related client specific web documents for Step Therapy and Prior Authorization Guidelines required by CMS/States.
• Provides direct client consultation on CMS/States statutory regulations and CMS/States issued regulatory guidance to ensure continued CMS/States formulary approval.
• Ensures appropriate, accurate, and consistent client specific formulary claims adjudication, formulary flat file and Plan Finder file concordance.  Provides direct client consultation on all Formulary Administration and Strategy operations, programs, and software.
• Responsible for accurate and timely task estimation and status reporting to Director, Formulary Administration & Strategy.  Executes within the confines and timeframes provided by CMS/States which may include non- standard business hours.

Supervisory Responsibilities

Directly supervises assigned staff in the Formulary Administration & Strategy department. Carries out supervisory responsibilities in accordance with the organization's policies and applicable laws. Responsibilities include interviewing, hiring, and training employees; planning, assigning, and directing work; appraising performance; rewarding and disciplining employees; addressing complaints and resolving problems.

Qualifications To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Client Responsibilities

This is an internal and external client facing position that requires excellent customer service skills and interpersonal communication skills (listening/verbal/written). One must be able to:

• Respond promptly to client needs
• Solicit client feedback to improve service
• Respond to requests for service and assistance from clients
• Meet commitments to clients
• Manage difficult or emotional client situations

Education and/or Experience

Pharm.D. from an accredited school of pharmacy (or equivalent combination of education and experience such as a bachelor’s pharmacy degree) along with 5-7+ years related experience.  

Computer Skills

To perform this job successfully, the individual should have knowledge of Microsoft Office Suite, MS Outlook, and relational databases.

Certificates, Licenses, Registrations

Valid Registered Pharmacist license in the State of California or equivalent state.

Other Skills and Abilities

• Prior experience in PBM formulary setup and maintenance, relational and analytical database management programs, as well as, familiarity with First DataBank, Medi-Span and RxNorm drug files preferred.
• Prior experience with Medicare Part D, Medicaid, Health Insurance Exchange and/or Commercial formulary development and maintenance processes highly desirable.
• Must be able to execute and deliver within the confines and timeframes provided by CMS/States which may include non-standard business hours.
• Prior management experience preferred.

Reasoning Ability

Ability to define problems, collect data, establish facts, and draw valid conclusions. Ability to interpret an extensive variety of technical instructions in mathematical or diagram form and deal with several abstract and concrete variables.

Mathematical Skills

Ability to work with mathematical concepts such as probability and statistical inference, and fundamentals of plane and solid geometry and trigonometry.  Ability to apply concepts such as fractions, percentages, ratios, and proportions to practical situations.

Language Skills

Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, or governmental regulations.  Ability to write reports, business correspondence, and procedure manuals.  Ability to effectively present information and respond to questions from groups of managers, clients, customers, and the general public.

Competencies

To perform the job successfully, an individual should demonstrate the following competencies:

• Problem Solving - Identifies and resolves problems in a timely manner; Gathers and analyzes information skillfully; Develops alternative solutions; Works well in group problem solving situations; Uses reason even when dealing with emotional topics.

• Oral Communication - Speaks clearly and persuasively in positive or negative situations; Listens and gets clarification; Responds well to questions; Demonstrates group presentation skills; Participates in meetings.

• Written Communication - Writes clearly and informatively; Edits work for spelling and grammar; Varies writing style to meet needs; Presents numerical data effectively; Able to read and interpret written information.

• Managing People - Includes staff in planning, decision-making, facilitating and process improvement; Takes responsibility for subordinates' activities; Makes self-available to staff; Provides regular performance feedback; Develops subordinates' skills and encourages growth; Solicits and applies customer feedback (internal and external); Fosters quality focus in others; Improves processes, products, and services. Continually works to improve supervisory skills.

• Strategic Thinking - Develops moderate strategies to achieve organizational goals; Understands organization's strengths & weaknesses; Identifies external threats and opportunities; Adapts strategy to changing conditions.

Physical Demands The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this Job, the employee is regularly required to sit and talk or hear. The employee is frequently required to use hands to finger, handle, or feel. The employee is occasionally required to stand; walk and reach with hands and arms. The employee must occasionally lift and/or move up to 10 pounds.

Work Environment The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

The noise level in the work environment is usually

Working Hours This is an exempt level position requiring the incumbent to work the hours required to fully accomplish job responsibilities and reasonable meet deadlines for work deliverables. The individual must have the flexibility to work beyond traditional hours and be able to work nights, weekends or on holidays as required. Work hours may be changed from time to time to meet the needs of the business. Typical core business hours are Monday through Friday from 8:00am to 5:00pm.

The Perks:

• Medical / Dental / Vision / Wellness Programs
• Paid Time Off / Company Paid Holidays
• Incentive Compensation
• 401K with Company match
• Life and Disability Insurance
• Tuition Reimbursement
• Employee Referral Bonus

To explore all that MedImpact has to offer, and the greatness you can bring to our teams, please submit your resume to www.medimpact.com/careers

MedImpact, is a privately-held pharmacy benefit manager (PBM) headquartered in San Diego,
California. Our solutions and services positively influence healthcare outcomes and expenditures, improving the position of our clients in the market. MedImpact offers high-value solutions to payers, providers and consumers of healthcare in the U.S. and foreign markets.

Equal Opportunity Employer, Male/Female/Disabilities/Veterans

OSHA/ADA:

To perform this job successfully, the successful candidate must be able to perform each essential duty satisfactorily. The requirements listed are representative of the knowledge, skill, and/or ability required.
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Disclaimer:

The above
statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified.