Manager, Formulary Design and Strategy

Role Overview

• Leads the creation of formulary design best practices and industry-leading, market-competitive formulary management strategies across all CareSource lines of business and markets
• Manages the CareSource RXInnovations Value Assessment Committee including preparation of meeting materials and presentations, and education of stakeholders following committee meetings
• Directs and ensures the efficient operational management of the formulary management team with emphasis on execution, outcomes, continual improvement and performance enhancement
• Oversees the monitoring of and educates stakeholders on the drug development pipeline and strategies we will employ to appropriately manage new and existing drugs
• Works with appropriate business partners to ensure accurate and timely implementation of formulary changes by PBM
• Monitors the formulary change process to minimize member disruption but drive value and better member outcomes
• Supports leadership in direct rebating decisions and negotiations in collaboration with pharmaceutical manufacturers
• Creates, monitors, and reports monthly on key performance indicators (KPIs) related to formulary management, including but not limited to cost and member, provider and/or drug utilization
• Ensures team collaboration with Clinical Program Managers to create and improve programs that drive better member health outcomes
• Leads the identification, quantification and measurement of total cost of care savings opportunities related to formulary management and other drug management techniques
• Collaborates with other teams to communicate and educate members, providers, pharmacies, and internal business partners on formulary, prior authorizations, specialty drugs and other initiatives
• Ensures regulatory and compliance guidelines are met for Medicaid, Medicare, Exchange and future lines of related to formulary management and the development of clinical policies and criteria
• Develops policies, trainings, and procedures to ensure compliance with new and existing regulations and accreditation standards
• Analyzes data regularly to identify process improvement opportunities relating to formulary management, as well as clinical policy and criteria development
• Accountable for motivating, hiring, training, coaching, professional development, succession planning, performance appraisals, and disciplinary actions of staff
• Advises and precepts APPE students and residents
• Participates in department and team initiatives and projects
• Participates in relevant pharmacy research projects and educational programs

Requirements

• Bachelor’s Degree in Pharmacy or Pharmacy Degree (PharmD) required
• Master’s in Business Administration or related is preferred
• Minimum of five (5) years of managed care experience required
• Minimum of two (2) years of formulary management experience
• Experience participating in or leading a P&T, Value Assessment Committee, or Drug Utilization Review Board required
• Previous management experience is required
• Experience working with multiple lines of business (commercial or government lines of business (Medicare, Medicare, or Marketplace)) or multiple states is preferred
• Experience with state-mandated formularies preferred
• Proficiency in Microsoft Word and Outlook and advanced proficiency in PowerPoint and Excel
• Familiarity with medical terminology

Benefits

• Bonuses tied to company and individual performance
• Substantial and comprehensive total rewards package