Pharmacist - Formulary & UM Oversight Strategist

EmblemHealth; New York (NY); On-site; USD 92,880 - 178,200; Full time

Job summary

EmblemHealth in New York seeks an experienced pharmacist leader to set Pharmacy Utilization Management criteria and oversee decision trees, ensuring clinical appropriateness and alignment with P&T decisions.

You will partner with pharmacy analytics, finance, and operations to finalize disruption analysis, monitor rebates, and implement formulary changes while ensuring regulatory compliance.

Qualifications

• Doctor of Pharmacy degree required.
• Registered Pharmacist license required.
• 10–12+ years of relevant experience.
• Knowledge of formulary utilization management techniques.
• Knowledge of pharmaceuticals and disease states to provide advice to providers and members.
• Possess research and analytical skills to provide problem resolution.
• Excellent verbal and written communication skills.

Responsibilities

• Develop, implement, and maintain preferred formulary drug lists.
• Develop preferred formulary drug lists across Medicare Part D, Medicaid, Commercial, Healthcare Exchange.
• Evaluate and maintain formulary set-up based on clinical requirements and regulatory rules.
• Maintain clinical tools up to date with current formulary policies.
• Provide education on formulary updates including quarterly and annual changes.
• Serve as SME for escalated formulary issues and audits.
• Review weekly reports to identify trends and compliance.
• Work with IT to maintain formulary list updates.
• Identify and target prescribing outliers.
• Collaborate with actuary to determine cost-saving alternatives.
• Manage the Pharmacy & Therapeutic Committee/Formulary Management and Drug Policies.

Skills

Formulary utilization management

Stakeholder collaboration

Data analysis

Regulatory knowledge

Education

Doctor of Pharmacy degree

Pharmacist license

Job description

EmblemHealth in New York seeks an experienced pharmacist leader to set Pharmacy Utilization Management criteria and oversee decision trees, ensuring clinical appropriateness and alignment with P&T decisions.

You will partner with pharmacy analytics, finance, and operations to finalize disruption analysis, monitor rebates, and implement formulary changes while ensuring regulatory compliance.