Medicare Part D Formulary Operations Pharmacist

Judi Health, LLC; United States; Hybrid; USD 125,000 - 135,000; Full time

Job summary

Judi Health in the United States is seeking a Formulary Operations Pharmacist – Medicare to provide operational support for evaluating, implementing, and maintaining Medicare Part D formularies and related processes. You will collaborate across teams to prepare CMS submissions, maintain drug lists, and ensure compliance with CMS rules.

The role requires strong cross-functional communication and a deep understanding of Medicare formulary management, with potential support for non-Medicare tasks

Qualifications

• Doctor of Pharmacy (PharmD) degree from an accredited institution.
• Current, unrestricted pharmacists 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 highly managed specialty medications/strategy.
• 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.
• Exceptional written and verbal communication skills.
• Extremely flexible, highly organized, and able to shift priorities easily.
• Attention to detail & commitment to delivering high quality work product.
• Proficient in Microsoft office suite with strong emphasis in Microsoft Excel required.

Responsibilities

• Maintain standard and custom formularies for the Medicare line of business per CMS guidelines.
• Support development, implementation, maintenance, and quality control of Medicare Part D formularies, utilization management, and clinical adjudication drug lists.
• Lead and support monthly/annual CMS formulary submissions, member drug lists, and utilization management criteria.
• Expand scope to non-Medicare lines when needed to drive alignment and execution.
• Evaluate drugs to inform formulary positioning and updates to management strategies.
• Operationalize client formulary and benefit change requests within the adjudication platform.
• Create customized marketing materials and documentation.
• Support testing of client formulary and benefit elections.
• Support client trade and rebate strategy evaluations.
• Identify automation opportunities and collaborate with Analytics to streamline workflows.
• Analyze pharmacy cost of care and clinical updates for formulary programs.
• Provide clinical support to teams during implementations.
• Serve as clinical ops liaison for ad-hoc sales requests and client insights.

Skills

Medicare formulary experience

Data analysis

Communication skills

Project management

Attention to detail

Education

Doctor of Pharmacy (PharmD)

Tools

Microsoft Excel

Microsoft Office

Job description

Judi Health in the United States is seeking a Formulary Operations Pharmacist – Medicare to provide operational support for evaluating, implementing, and maintaining Medicare Part D formularies and related processes. You will collaborate across teams to prepare CMS submissions, maintain drug lists, and ensure compliance with CMS rules.

The role requires strong cross-functional communication and a deep understanding of Medicare formulary management, with potential support for non-Medicare tasks