Formulary Lead, Formulary Operations

This is a fully remote position, open to applicants in Alabama, +34 more locations.

📋 Description

• Conduct research and secure approval from Formulary Operations Leadership for all proposed FAC and P&T modifications based on the Navitus foundational setup, software capabilities, and implementation timelines.

• Relay and document all sanctioned FAC and P&T modifications to internal teams and client stakeholders for endorsement, including client feedback.

• Generate comprehensive change spreadsheets detailing necessary formulary alterations and client decisions from FAC and P&T for input into FBMS by Formulary Operations Specialists.

• Transform formulary data from the Formulary Advisory Committee, Pharmacy and Therapeutics committee, Medi-span, and Account Management into the Formulary and Benefit Management System (FBMS).

• Make autonomous decisions regarding formulary configuration and upkeep when designing and constructing new formularies for bespoke clients.

• Oversee the creation and dissemination of formulary documents, including web content, e-prescribing information, formularies, change notifications, and medication program lists.

• Evaluate, assign, and supervise Formulary Change Requests, New Client Formulary Implementations, operational formulary clean-ups, and project SME requests.

• Uphold P&Ps and standard operating procedures pertinent to daily operations.

• Support Formulary Operations Specialists with problem resolution and troubleshooting.

• Address formulary and setup inquiries.

• Engage in meetings and committees as requested or designated.

• Carry out additional tasks as assigned.

⛳️ Requirements

• A minimum of a High School diploma alongside specialized expertise related to PBM practices and business software applications is mandatory.

• Pharmacy technician certification/experience is essential, with further education beyond high school strongly preferred.

• A minimum of 2-5 years of experience involving formulary information is required.

• Demonstrated analytical, problem-solving, and strong written and verbal communication skills.

• Experience in PBM/Managed healthcare claims processing is essential.

• Must be adept at communicating with vendors, external, and internal clients.

• Must possess a working knowledge of pharmacy practices, including drug names (brand vs. generic, NDC, GPI) and claims processing experience (either from managed care or community practice).

• Familiarity with prescription drug formularies is required.

• Experience with the maintenance of formulary setups and documents is necessary.

• Strong computer proficiency (Excel, Word, Outlook) is required.

• Engage in, comply with, and support compliance program objectives.

• The ability to consistently interact cooperatively and respectfully with colleagues is essential.

🏝️ Benefits

• Comprehensive industry-leading benefits for Health, Dental, and Vision insurance.

• 20 days of paid time off.

• 4 weeks of paid parental leave.

• 9 paid holidays.

• 401K company match of up to 5% - No vesting requirement.

• Adoption Assistance Program.

• Flexible Spending Account.

• Educational Assistance Plan and support for Professional Memberships.

• Referral Bonus Program – up to $750!