Medicare Formulary Strategy Pharmacist

JobRx, Inc.; Charlotte (NC); Hybrid; USD 125,000 - 135,000; Full time

Job summary

Judi Health in the United States is seeking a Formulary Operations Pharmacist - Medicare to support evaluation, implementation, and maintenance of Medicare Part D formularies and utilization management. You will prepare CMS files, member formulary drug lists, and look up tools while collaborating across teams on CMS rules and regulations.

The role requires strong cross-functional communication, 2+ years of Medicare formulary experience, and PharmD licensure.

Qualifications

• Doctor of Pharmacy (PharmD) Degree from an accredited institution.
• Current, unrestricted registered pharmacist license(s).
• Residency/fellowship preferred.
• 2+ years of Medicare formulary experience working for a health plan or PBM.
• Knowledge of formulary development and maintenance processes.
• Knowledge of rebate and financial implications of formulary strategies.
• Experience working with large datasets required.
• Ability to independently identify, research, and resolve issues.
• Ability to balance multiple complex projects simultaneously.
• Ability to work extended hours, weekends, and holidays consistent with industry demands.
• Excellent written and verbal communication skills.
• Proficient in Microsoft office suite with strong emphasis on Microsoft Excel.

Responsibilities

• Maintain standard and custom formularies for the Medicare line of business in accordance with CMS Medicare guidelines.
• Supports the development, implementation, maintenance, and quality control of Medicare Part D formularies, utilization management, and clinical adjudication drug lists.
• Leads and supports the preparation of monthly and annual files for CMS formulary submissions, member formulary drug lists and look up tools, and utilization management criteria.
• Expanded scope of responsibilities across other non-Medicare business lines when needed, driving alignment and operational excellence.
• Evaluate drugs and drug classes, to provide formulary positioning and utilization management recommendations.

Skills

Attention to detail

Communication skills

Project management

Flexibility

Time management

Education

Doctor of Pharmacy (PharmD)

Licensed pharmacist

Residency preferred

Tools

Microsoft Excel

Job description

Judi Health in the United States is seeking a Formulary Operations Pharmacist - Medicare to support evaluation, implementation, and maintenance of Medicare Part D formularies and utilization management. You will prepare CMS files, member formulary drug lists, and look up tools while collaborating across teams on CMS rules and regulations.

The role requires strong cross-functional communication, 2+ years of Medicare formulary experience, and PharmD licensure.