Clinical Pharmacist, Formulary Services

Abarca Health LLC.; San Juan (PR); Hybrid; USD 95,000 - 125,000; Full time

Job summary

Abarca Health LLC in Puerto Rico is seeking a Clinical Pharmacist for Formulary Services to develop and implement Medicare, Medicaid, and Exchange formulary programs while ensuring compliance with regulatory guidelines.

You will lead configuration setup for new client implementations, resolve adjudication issues, and provide client-facing demos of the PBM platform, collaborating with teams to meet client needs and drive formulary design improvements.

Qualifications

• Doctoral Degree in Pharmacy is required.
• Current/Active Pharmacy License is required.
• 3+ years of formulary management experience in clinical operations and PBM.
• Experience working within clinical scenarios.
• Excellent oral and written communication skills.
• Hybrid work model with required on-site days at Puerto Rico location.

Responsibilities

• Develop and implement Medicare, Medicaid, and Exchange formulary programs.
• Ensure compliance with external regulator guidelines to keep operations compliant.
• Independently resolve adjudication and processing issues and advise on root cause and corrective action.
• Provide client-facing demos on the PBM configuration platform.
• Lead configuration setup for new client implementations and changes for existing clients.
• Provide consultative support to clients and internal teams.
• Monitor workload assignments and optimize configuration processes.
• Identify opportunities to improve inventory management and standards for configuration.

Skills

Oral and written communication

Clinical operations experience

Formulary management

Pharmacy benefit management

Education

Doctoral Degree in Pharmacy

Active Pharmacy License

Master’s Degree

Job description

Description

What you’ll do

In a few words… Abarca is igniting a revolution in healthcare. We built our company on the belief that with smarter technology we are redefining pharmacy benefits, but this is just the beginning…

Our Clinical Pharmacist for Formulary Services, you will be responsible for developing and implementing Medicare, Medicaid, and Exchange formulary programs while ensuring compliance with external regulatory guidelines. Independently resolve adjudication and processing issues, provide client-facing demos on the PBM configuration platform, and lead configuration setup for new client implementations and changes.

The fundamentals for the job…

• Develop and implement Medicare, Medicaid, and Exchange formulary programs.
• Stay current with external regulator guidelines to make timely adjustments to operations ensuring our processes follow the rules and regulations.
• Both independently perform as well as consult and advise the team through research and resolution of adjudication and processing issues including, identification of root cause, impact analysis determination and corrective action.
• Resolution & Ownership of project-based work as assigned.
• Perform client or prospect client facing to present demos around the PBM configuration platform.
• Primary support for configuration setup for new Medicare, Medicaid, Commercial and Employer client implementations, as well as configuration changes for existing clients.
• Provide consultative support to clients as well as internal teams.
• Monitor and distribute the workload assignment of the configuration team.
• Identify opportunities and solutions in inventory management that advance efficiency and standards for configuration.
• Collaborate and coordinate both within the configuration teams and with other business units to execute configuration as required.
• Manage client benefit operational calls, key client meetings and requests by capturing significant discussion topics and action items as well as sharing input and solutions to address client needs., considering Abarca’s priorities.
• Continuously develop and maintain an in-depth understanding of Darwin (proprietary adjudication platform) system logics to ensure designs are configured to meet client requirements with accuracy.
• Take part in the Pharmacy & Therapeutics Committee preparing presentations and clinical recommendations for new drugs.
• Research and remain informed of current and emerging trends in formulary and benefit design.
• Actively participate in government and internal audits.
• Engage in CMS Medicare STAR initiatives and clinical programs, as well as Medicare Plan Finder and PDE processes.
• Lead the team through process improvement efforts and recommendations.
• Develop process documentation, including Policies and Procedures, to document Benefit Administration operational processes.
• Support training new team members in configuration setup and standardized quality procedures.

Requirements

What we expect of you

The bold requirements…

• Doctoral Degree in Pharmacy.
• Current/Active Pharmacy License.
• 3+ years of experience with formulary management within clinical operations, and pharmacy benefit management.
• Experience working within clinical scenarios.
• Excellent oral and written communication skills.
• We are proud to offer a flexible hybrid work model which will require certain on-site work-days (Puerto Rico Location Only)
• This position requires availability to work in a specified time zone or working schedule, accommodating the business needs of our clients and team members.
• This position may require availability for on-call hours, including evenings, weekends, and holidays, to promptly address emergent issues or provide necessary support as dictated by operational demands (if applicable).

Nice to haves...

• Experience with pharmacy benefit management clinical operations and Medicare Part D.
• Master’s Degree.

Physical Requirements

• Must be able to access and navigate each department at the organization’s facilities.
• Sedentary work that primarily involves sitting/standing.

At Abarca we value and celebrate diversity. Diversity, equity, inclusion, and belonging are guiding principles of Abarca and ensure Abarca’s workforce reflects the communities it serves. We are proud to provide equal employment opportunities to all employees and applicants for employment and prohibit discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, medical condition, genetic information, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.

Abarca Health LLC is an equal employment opportunity employer and participates in E-Verify. Abarca Health LLC does not sponsor employment visas at this time.

The above description is not intended to limit the scope of the job or to exclude other duties not mentioned. It is not a final set of specifications for the position. It’s simply meant to give readers an idea of what the role entails.