Medicare Part D Clinical Pharmacist – Formulary Strategist

Doctors HealthCare Plans, Inc.; Coral Gables (FL); On-site; USD 110,000 - 140,000; Full time

Job summary

Doctors HealthCare Plans, Inc. seeks a Clinical Pharmacist to lead Part D coverage determinations, formulary management, and cost‑saving initiatives.

You will work with prescribers to promote cost‑effective prescribing and develop educational materials for providers. You'll oversee Medicare Part D compliance, drug reviews for the Pharmacy & Therapeutics Committee, and implement formulary changes with the PBM, in collaboration with the Pharmacy Director and cross‑functional teams.

Qualifications

• Managed Care experience preferred but not required.
• Part D Coverage Determinations experience preferred but not required.
• Part D Formulary Management experience preferred but not required.
• FRF submission experience preferred but not required.
• Strong communication and presentation skills.
• Doctor of Pharmacy Degree (PharmD) or Bachelor of Pharmacy Degree (RPh) with clinical experience or residency.
• Current and unrestricted State of Florida license.

Responsibilities

• Formulary management and FRF submissions in HPMS.
• Drug monographs for New Drug Entity Reviews.
• Development of education material for providers.
• Member medication reviews for polypharmacy and inappropriate prescribing.
• PBM rebate strategy implementation and oversight.
• Pharmacy & Therapeutics Committee meetings and CMS formulary updates.
• Coverage determinations and monitoring of cost‑effective drug management.
• Medical necessity reviews for formulary exceptions and prior authorizations.

Skills

Strong communication

Presentation skills

MS Office

Programming or reporting software

Education

PharmD or RPh with clinical experience or PGY1 residency in managed care

Florida license

Tools

Microsoft Office

Reporting software

Job description

Doctors HealthCare Plans, Inc. seeks a Clinical Pharmacist to lead Part D coverage determinations, formulary management, and cost‑saving initiatives.

You will work with prescribers to promote cost‑effective prescribing and develop educational materials for providers. You'll oversee Medicare Part D compliance, drug reviews for the Pharmacy & Therapeutics Committee, and implement formulary changes with the PBM, in collaboration with the Pharmacy Director and cross‑functional teams.