Clinical Account Consultant Pharmacy - Medicare Formulary Strategy

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Job Summary

The Clinical Acct Consult Pharmacy - Medicare Formulary Strategy is responsible for multiple aspects of the development and execution of Medicare Part D formulary strategy in accordance with CMS 42 C.F.R. §423.100, 120 Prescription Drug Benefit Manual Chapter 6- “Part D Drugs and Formulary Requirements” to ensure the health plan’s formularies meet regulatory requirements and HCSC goals.

Key Duties and Responsibilities:
• Contributes to daily, monthly, and annual formulary development activities
• Leads and/or supports Medicare internal formulary development subcommittee discussions and ensures appropriate execution of decisions
• Develops and updates formulary utilization management (UM) criteria: prior authorization (PA), step therapy (ST), and quantity limits (QL)
• Assists in development of annual formularies in collaboration with the Product, Actuary and Contracting departments
• Contributes to the annual Part D bid development by providing formulary files and assumptions, as well as documents required for P&T Committee review and approval
• Ensures complete modeling and evaluation of drug contract offers and act as drug manufacturer clinical point of contact
• Communicates changes to the PBM and ensures execution of formulary strategies
• Collaborates with the Coverage Determination (CD) unit to implement UM changes and develop decision trees for drugs with UM and select non-formulary drugs
• Partners with key stakeholders of formulary strategy outcomes and ensures collaboration to achieve goals
• Assists with formulary submission outlier review process
• Maintains formulary-related policies and procedures and job aids

Required Job Qualifications:
* Registered Pharmacist
* 4 years of managed care pharmacy experience or 4 years of consulting experience in the pharmacy benefits industry (completion of managed care residency can substitute for 4 years of managed care pharmacy experience requirements)
* Knowledge of pharmacy benefits products, services and concepts
* Analytical skills including developing reports and synthesizing data to tell a story and develop recommendations
* Written and verbal communications skills including developing presentations and presenting to external business leaders or large audiences
* Collaboration skills to work across organization on problem resolution, negotiation, consensus building, conflict management, and decision-making skills
* Relationship building skills to build strong customer relationships
* Project management skills and experience
* Experience with Microsoft Office applications (Word, Excel, PowerPoint) and clinical/business databases
 

Preferred Job Qualifications:

* Pharm.D. preferred
* Managed care pharmacy residency
* 2 or more years of Medicare Part D experience
* Knowledge of Medicare Part D regulatory requirements
* Knowledge of computer applications, including pharmacy claims systems
* Proficiency in Microsoft platform functionality (e.g., Word, PowerPoint, Excel)
* Understanding of formulary development and/or maintenance
* Formulary development and strategy experience

This is a Flex (Hybrid) role: 3 days in office; 2 days work from home.
Sponsorship is not available.

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Pay Transparency Statement:

At Health Care Service Corporation, you will be part of an organization committed to offering meaningful benefits to our employees to support their life outside of work. From health and wellness benefits, 401(k) savings plan, pension plan, paid time off, paid parental leave, disability insurance, supplemental life insurance, employee assistance program, paid holidays, tuition reimbursement, plus other incentives, we offer a robust total rewards package for employees.  Learn more about our benefit offerings by visiting https://careers.hcsc.com/totalrewards.

The compensation offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plan subject to the terms and the conditions of the plan.

HCSC Employment Statement:

We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics.

Base Pay Range

$102,000.00 - $184,300.00

Exact compensation may vary based on skills, experience, and location.