Manager, Formulary Design and Strategy

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🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $113k - $197.7k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

✍️ Designer

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CareSource

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 30+ years

⚕️ Healthcare Insurance

Healthcare Insurance

CareSource is a health services company focused on providing affordable health insurance and healthcare solutions. It offers a wide range of plans including Medicaid, Marketplace, and Medicare Advantage, targeting low-income adults, families, children, pregnant women, elderly adults, and people with disabilities. Additionally, CareSource provides members with resources for COVID-19 support, dental, vision, and hearing benefits, as well as pharmacy services. The company emphasizes easy access to healthcare management through online platforms and a mobile app.

📋 Description

• Leads the creation of formulary design best practices and industry-leading, market-competitive formulary management strategies across all CareSource lines of business and markets • Manages the CareSource RXInnovations Value Assessment Committee including preparation of meeting materials and presentations, and education of stakeholders following committee meetings • Directs and ensures the efficient operational management of the formulary management team with emphasis on execution, outcomes, continual improvement and performance enhancement • Oversees the monitoring of and educates stakeholders on the drug development pipeline and strategies we will employ to appropriately manage new and existing drugs • Works with appropriate business partners to ensure accurate and timely implementation of formulary changes by PBM • Monitors the formulary change process to minimize member disruption but drive value and better member outcomes • Supports leadership in direct rebating decisions and negotiations in collaboration with pharmaceutical manufacturers • Creates, monitors, and reports monthly on key performance indicators (KPIs) related to formulary management, including but not limited to cost and member, provider and/or drug utilization • Ensures team collaboration with Clinical Program Managers to create and improve programs that drive better member health outcomes • Leads the identification, quantification and measurement of total cost of care savings opportunities related to formulary management and other drug management techniques • Collaborates with other teams to communicate and educate members, providers, pharmacies, and internal business partners on formulary, prior authorizations, specialty drugs and other initiatives • Ensures regulatory and compliance guidelines are met for Medicaid, Medicare, Exchange and future lines of related to formulary management and the development of clinical policies and criteria • Develops policies, trainings, and procedures to ensure compliance with new and existing regulations and accreditation standards • Analyzes data regularly to identify process improvement opportunities relating to formulary management, as well as clinical policy and criteria development • Accountable for motivating, hiring, training, coaching, professional development, succession planning, performance appraisals, and disciplinary actions of staff • Advises and precepts APPE students and residents • Participates in department and team initiatives and projects • Participates in relevant pharmacy research projects and educational programs

🎯 Requirements

• Bachelor’s Degree in Pharmacy or Pharmacy Degree (PharmD) required • Master’s in Business Administration or related is preferred • Minimum of five (5) years of managed care experience required • Minimum of two (2) years of formulary management experience • Experience participating in or leading a P&T, Value Assessment Committee, or Drug Utilization Review Board required • Previous management experience is required • Experience working with multiple lines of business (commercial or government lines of business (Medicare, Medicare, or Marketplace)) or multiple states is preferred • Experience with state-mandated formularies preferred • Proficiency in Microsoft Word and Outlook and advanced proficiency in PowerPoint and Excel • Familiarity with medical terminology

🏖️ Benefits

• Bonuses tied to company and individual performance • Substantial and comprehensive total rewards package