Medicare Part D Formulary Pharmacist

Salt Lake City UT 84101 170 South Main

Job Description

This position is accountable for developing and maintaining the Part D formulary and related processes for the Magellan Rx Medicare business unit. This individual must be subject matter expert in Medicare Part D Drugs and Formulary Requirements and have a strong knowledge of Coverage Determinations, Appeals, Grievances, Drug Utilization Programs, Medication Therapy Management, Transition Fills, and Medicare Claims adjudication. This pharmacist will be working with multidisciplinary health care professionals, non-clinical operational staff, and hold client facing responsibilities in an advisory and facilitation role. Partners with other Medicare Part D team members to ensure that Magellan Rx Medicare delivers the highest quality Medicare product in the Prescription Drug Plan (PDP), Medicare Advantage Prescription Drug Plan (MA-PD), and Employer Group Waiver Plan (EGWP) marketplace.
  • Develops strong relationships with key internal customers to assist with delivering client needs related to clinical programs, formulary development, and Medicare Part D related topics.
  • Conducts formulary development and optimizes the delivery of the Medicare Part D benefit for Prescription Drug Plan (​PDP), Medicare Advantage Plan (MAPD), and Employer Group Waiver Plans (EGWP) clients
  • Manages formularies and criteria for the purposes of adjudication and publishing on prescription drug lists and websites in line with the decisions from the drug review committees and in response to client requests.
  • Monitors for new drugs on the weekly drug file and apply appropriate drug statuses to formularies.
  • Ensures quality of the formulary by performing regular reviews of various available reports.  This will require a working knowledge of common pharmacy data points.
  • Manages communications for members, clients, prescribers, pharmacies, and internal stakeholders regarding formulary changes in the form of emails, traditional mailings, and publications.
  • Provides support to client-specific Pharmacy and Therapeutics Committee functions, Drug Utilization Review (DUR) committees and responsibilities. 
  • Supports customer service and prior authorization inquiries specific to assigned accounts
  • Researches and explains clinical and business aspects of drugs and drug strategies to internal business partners. 
  • Participates in internal meetings to support and present relevant information as needed. 
  • Provides subject matter expertise to troubleshoot formulary related matters.
  • Functions as the liaison between several groups to ensure end to end formulary management.
  • Collaborates with Medicare Part D department to develop and maintain a compliant Medicare Part D program.
  • Contributes to and participates in clinical and/or financial committee meetings that mange drug review. 
  • Performs drug and class reviews as needed. 
  • Creates strategy recommendations regarding drugs, classes, and utilization management edits/criteria.
  • Manages documentation and actionable items from meetings. 
  • Participates in documenting team procedures and create checklists that capture best practices for the operational work the team performs.
  • Provides assistance in audits and responses to Centers for Medicare & Medicaid Services (CMS) related to formulary administration topics.
  • Works with data analytics to create reporting tools and dashboards related to Medicare Part D drug benefit.
  • Performs other duties as assigned.

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General Job Information

Title

Medicare Part D Formulary Pharmacist

Grade

29

Job Family

Pharmacy Group

Country

United States of America

FLSA Status

United States of America (Exempt)

Recruiting Start Date

5/4/2019

Date Requisition Created

5/4/2019

Work Experience

Pharmacy

Education

Bachelors: Pharmacy (Required), PharmD

License and Certifications - Required

RPH - Registered Pharmacist - Pharmacy

License and Certifications - Preferred

Other Job Requirements

Responsibilities

  • Proficiency in MS Office Suite, specifically Word, Excel, PowerPoint (Visio and Access are a plus).
  • Minimum of 2 years of pharmacy experience in retail, mail order, health plan, PBM or similar setting as a pharmacist or pharmacy resident.
  • Knowledge of prescription drugs, disease states, therapy classes, health plan formulary management techniques, prescription plan benefit designs, current healthcare industry news and trends.
  • Project management skills.
  • Ability to perform in an environment with changing priorities and comfortable multi-tasking
  • Ability to meet short turnaround times with minimal oversight and deadline driven.
  • Excellent written and verbal communication skills.
  • Strong analytical skills with ability to identify and solve problematic issues.
  • Detail-oriented.
  • Team player and treats colleagues with respect.
  • Ability to take direction and also self manage day-to-day duties and tasks assigned.
  • Ability to quickly learn various computer systems and software.

Magellan Health Services is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled. Every employee must understand, comply and attest to the security responsibilities and security controls unique to their position.

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