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.

Senior Formulary Specialist

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Manager & Professional
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191AZ Requisition #
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Responsible for development and maintenance activities for formularies for one or more of 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.

Responsibilities:
  • Evaluate and maintain formulary set-up based on clinical requirements, compliance with regulatory bodies, and P&T rules.
  • Manage the Pharmacy & Therapeutic Committee/Formulary Management, including Step-Protocol Review, Non-Formulary Review, Subcommittee Management (Meetings/minutes), Drug Reviews, and Updates and Drug Policies,  for all medications.
  • Manage utilization management tools, including review and update of pharmacy and medical policies, and Criteria for Medical Necessity (CMN) reviews for all medications to ensure alignment with formulary intent.
  • Maintain clinical tools utilized by pharmacy services for purpose of remaining up to date and compliant with current pharmacy policies.  
  • Serve as subject matter expert for all escalated clinical formulary related issues as well as for all formulary related internal and external audits. 
  • Other duties/projects as assigned.
Qualifications:
  • Doctor of Pharmacy degree or Masters in Pharmacy from an accredited school of pharmacy with clinical and drug information experience
  • Registered Pharmacist: New York State pharmacy license or eligible to obtain New York State license
  • A minimum of 10 years of relevant experience preferred
  • Residency or 5 years’ clinical experience preferred
  • Knowledge of formulary utilization management practices required
  • Knowledge of formulary management preferred
  • Knowledge of pharmaceuticals and disease states to provide advice and consultation to providers and members, and recommend changes to the formulary required
  • Possess research and analytical skills sufficient to provide problem resolution and consultation to providers required
  • Excellent verbal and written communication skills sufficient to prepare own correspondence and interact with members and providers in provision of advice and guidelines required

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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