Company Statement

For the last 80 years, EmblemHealth has been taking care of New York’s heart and soul, its people. Today, health care is more complex than ever. That’s why we’re at the forefront of change. We work alongside our customers to offer access to high-quality, affordable care, help navigate the health care experience, and make good health achievable; because everyone deserves to be taken care of. We deliver on our mission every day by living our values with our colleagues, members, clients and partners. It begins with caring and respecting all those we work with. We believe a culture of diversity and inclusion is vital to serve our unique and diverse customers. We seek for continues improvement and innovation and believe being agile and nimble is our advantage. We bring a strong sense of partnership to every relationship – internally and externally. The EmblemHealth family of companies offers competitive health, welfare, and retirement benefits as well as incentive pay plans and more.

Lead Formulary Specialist

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Manager & Professional
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210DD Requisition #
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Manage the formulary development & management team.  Ensure compliant formulary filings for Medicare, Medicaid, Commercial, HIX in NY and CT. Responsible for development and maintenance activities for formularies on the following lines of business: Medicare Part D, Medicaid, Commercial, Healthcare Exchange. Use sound clinical judgment and knowledge of State and Federal regulations to ensure compliance with regulatory and contractual obligations. Ensure pharmacy drug policies are current, accurate and approved by the Pharmacy & Therapeutics Committee. Assist the Vice Chair of the P&T Committee in administering the P&T Committee requirements including gathering, reviewing and sharing all meeting materials for each quarterly meeting. Partner with PBM Clinical Account Executives to identify formulary improvement opportunities quarterly.  Ensure weekly drug changes are recorded and implemented accordingly.

Responsibilities

  • Manage the day to day functions of the Sr. Clinical Pharmacy Specialists ensuring all pharmacy drug changes are implemented as required.
  • Oversee and drive pharmacy formulary strategy for the enterprise.  This entails reviewing drug trends, examining utilization management, competitor strategies, and working with internal groups (actuary, medical economics, product, and ESI) to implement formulary strategies.
  • Manage the team and the formulary calendar ensuring all state and federal submissions are timely and accurate.
  • Participate in the Pharmacy & Therapeutic Committee to include: Step-Protocol Review, Non-Formulary Review, Subcommittee Management (Meetings/minutes), Drug Reviews, and Updates.
  • Partner with the product teams to identify and implement opportunities for formulary decisions to reduce cost and increase market competitiveness. 
  • Establish strong relationships with Pharma in support of identifying rebate and cost savings opportunities.

 

 

Qualifications

  • Doctor of Pharmacy degree or Masters in Pharmacy from an accredited school of pharmacy
  • Registered Pharmacist: New York State pharmacy license or eligible to obtain New York State license
  • Board certification (Pharmacotherapy, Ambulatory Care, Geriatrics, Internal Medicine, Pediatrics) preferred(P)
  • 7+years of relevant business experience (R)
  • A minimum of 2 years of management experience. (P)
  • A minimum of 5 years of pharmacist experience(R)
  • Residency or 5 years’ clinical experience preferred (P)
  • Knowledge of pharmaceuticals and disease states to provide advice and consultation to providers and members, and recommend changes to the formulary (R)
  • Possess research and analytical skills sufficient to provide problem resolution and consultation to providers (R)
  • Excellent verbal and written communication skills sufficient to prepare own correspondence and interact with members and providers in provision of advice and guidelines  (R)

EEOC Statement

We are committed to leveraging the diverse backgrounds, perspectives and experiences of our workforce to create opportunities for our people and our business. We are an equal opportunity/affirmative action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected veteran status or any other characteristic protected by law.

Sponsorship Statement

Depending on factors such as business unit requirements, the nature of the position, cost and applicable laws and regulations, EmblemHealth may provide work visa sponsorship for certain positions.

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