Formulary Administration Pharmacist

MedImpact Healthcare Systems, Inc.; San Diego (CA); On-site; USD 109,000 - 196,000; Full time

Job summary

MedImpact Healthcare Systems, Inc. is seeking a Formulary Administration Pharmacist to manage operational aspects of the Formulary Administration & Strategy team, ensuring accurate coding, documentation, and regulatory alignment.

The role focuses on quality control and analysis of client formulary setup, rule sets, and concordance with contract and regulatory requirements across multiple lines of business.

Qualifications

• PharmD and 3+ years’ experience or equivalent combination of education and experience.
• Registered Pharmacist in a U.S. state or territory.
• Advanced Microsoft Excel skills and data analysis.

Responsibilities

• Oversee formulary configuration, maintenance, and quality control.
• Translate clinical recommendations into operational implementations.
• Ensure regulatory compliance across commercial lines.
• Collaborate with Drug Information and Formulary Strategy for positioning decisions.
• Prepare documentation for clients and regulatory bodies.
• Lead cross-functional initiatives and report status to leadership.

Skills

Excel

Education

PharmD

Tools

Microsoft Excel

Microsoft Office Suite

Outlook

Relational databases

Job description

Exemption Status

United States of America (Exempt)

$108,515 - $152,464 - $196,412

“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!

Summary

Job Description

The Formulary Administration Pharmacist manages operational aspects of business unit, department; acts as the subject matter expert (SME) to lead and support the execution of strategic initiatives, projects, and/or programs under guidance of Director and/or Manager, Formulary Administration & Strategy. This position focuses on the efforts of the MedImpact Formulary Administration & Strategy Team in quality control and analysis of MedImpact client formulary set-up, rule sets, coding, accuracy, functionality, EOB, documentation, and concordance with client specified and regulatory requirements utilizing distinct but inter-related management and cross- departmental functions.

Essential Duties and Responsibilities

• Collaborates with Drug Information, Formulary Strategy, and Configuration Services to translate approved clinical recommendations and formulary strategies into accurate operational implementation. Oversee the coding, maintenance, quality control, validation, documentation, and distribution of formulary and utilization management data to ensure consistency across claims adjudication, formulary files, regulatory submissions, and client deliverables. Maintains knowledge of pharmacy benefit regulatory requirements and ensures compliance with applicable Federal and State regulations across all lines of business (e.g. Commercial and Health Insurance Exchange).
• Supports Formulary Administration operations across Commercial, Health Insurance Exchange, and other lines of business as assigned, including:
• Formulary and utilization management configuration, maintenance, quality control, implementation, and ongoing operational support.
• Collaborates with GPS, Compliance and other departments to ensure generation of regulatory compliance, reporting, and submission files.
• Collaborates with Formulary Strategy to ensure approved clinical and financial strategies are accurately operationalized and maintained within formulary systems and processes. Participates in meetings as necessary.
• Provides operational consultation and implementation support for custom client formulary and utilization management strategies.
• Support of Drug Management Committee meetings through operational consultation, documentation, implementation planning, and post-decision execution activities: attend meeting as clinical/operational support.
• Collaborates with Drug Information to implement and maintain approved recommendations for drug and utilization management positioning decisions (quantity limits, step edit and prior authorization guidelines) resulting from newly approved indications, therapeutic agents, patent expirations, FDA alerts and drug recalls or withdrawals.
• Researches and responds to formulary configuration, coding, implementation, and utilization management operational questions and partners with appropriate stakeholders regarding clinical rationale inquiries.
• 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.
• Ensures the accuracy, integrity, and synchronization of formulary data across claims adjudication systems, formulary files, regulatory submissions, member-facing materials, and client deliverables through established quality control and validation processes.
• Provides direct client consultation regarding formulary administration operations, implementation activities, formulary maintenance, coding processes and related system functionality.
• Responsible for accurate and timely task estimation and status reporting to Director/Manager, Formulary Administration & Strategy.
• Provides formulary-specific documentation of maintenance activities to clients and regulatory bodies as appropriate.
• Partners with other departments on a weekly, quarterly and ad hoc basis on the Formulary decision process. Contributes to internal and external client notifications of timely clinical issues through daily, monthly and quarterly established communications.
• Other duties may be assigned.

Supervisory Responsibilities

No supervisory responsibilities

Education And/or Experience

PharmD and 3+ years’ experience or equivalent combination of education and experience, and 1 year of SME in respective areas

Computer Skills

To perform this job successfully, an individual should have knowledge of Microsoft Office, Outlook and a working knowledge of relational databases.

Certificates, Licenses, Registrations

Registered Pharmacist in a U.S. state or territory.

Other Skills And Abilities

• Advanced Microsoft Excel skills, including data validation, pivot tables, formulas, analysis, and reconciliation of large datasets.
• Demonstrated ability to manage multiple projects and priorities, lead cross-functional initiatives, and drive work to completion with minimal supervision.

Reasoning Ability

• Ability to define problems, collect data, establish facts, and draw valid conclusions.
• Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.

Mathematical Skills

• Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. Ability to compute rate, ratio, and percent and to draw and interpret bar graphs.

Language Skills

• Ability to effectively present information in one-on-one and small group situations to customers, clients, and other employees of the organization.
• Ability to write routine reports and correspondence. Ability to speak effectively before groups of customers or employees of organization.

Competencies

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

• Composure
• Decision Quality
• Organizational Agility
• Problem Solving
• Customer Focus
• Drive for Results
• Peer Relations
• Time Management
• Dealing with Ambiguity
• Learning on the Fly
• Political Savvy

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 accommodation 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 regularly required to stand; walk; use hands to finger, handle, or feel and reach with hands and arms. The employee must occasionally lift and/or move up to 25 pounds. Ability to maintain clear near visual acuity at approximately 20 inches or less (i.e., “close vision”) to accurately read fine print, view computer screens, and handle small objects. Requires adequate color vision and depth perception to support safety and precision in detail-oriented tasks.

Work Environment

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

This position may regularly be exposed to or encounter moving