Formulary Lead, Formulary Operations

🔥 19 hours ago

🏈 Alabama, Arizona, +33 more states – Remote

🏈 Alabama – Remote 🌵 Arizona – Remote 🏄 California – Remote ⛰️ Colorado – Remote 🦌 Connecticut – Remote 🐊 Florida – Remote 🥔 Idaho – Remote 🌽 Illinois – Remote 🌾 Iowa – Remote 🌪️ Kansas – Remote 🐎 Kentucky – Remote ⚜️ Louisiana – Remote 🦬 Montana – Remote 🌾 Nebraska – Remote 🎰 Nevada – Remote 🏖️ New Jersey – Remote 🗽 New York – Remote 🌲 North Carolina – Remote 🏈 Ohio – Remote 🌪️ Oklahoma – Remote 🌲 Oregon – Remote 🦀 Maryland – Remote 🍂 Massachusetts – Remote 🚗 Michigan – Remote ❄️ Minnesota – Remote 🏰 Missouri – Remote 🔔 Pennsylvania – Remote 🎸 Tennessee – Remote 🤠 Texas – Remote ⛷️ Utah – Remote 🍁 Vermont – Remote ⚔️ Virginia – Remote ☕ Washington – Remote 🧀 Wisconsin – Remote 🍑 Georgia – Remote

💵 $56.8k - $68.4k / year

⏰ Full Time

🟠 Senior

⚙️ Operations

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Navitus Health Solutions

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 2003

💼 Consulting

🛡️ Insurance

🏥 Healthcare

Consulting • Insurance • Healthcare

Navitus Health Solutions is a pharmacy benefit manager (PBM) that provides transparent, people-centered pharmacy benefit solutions to health plans, employers, government programs and other plan sponsors. The company operates a 100% pass-through, cost-plus model that emphasizes lowering medication costs, managing formularies, specialty drug management (including a cost-plus specialty pharmacy), claims adjudication, pharmacy network management, and member enablement and support services. Navitus positions itself as a fiduciary partner focused on affordability, compliance, clinical quality and improving health outcomes through tailored PBM services and digital health integrations.

📋 Description

• Research and coordinate approval with Formulary Operations Leadership all proposed FAC and P&T changes based on Navitus base setup, functionality of software and timelines for implementation • Communicate and document all approved FAC and P&T changes to internal teams and client groups for approval, including client responses • Provide detailed change spreadsheets outlining required formulary changes and client decisions from FAC and P&T for entry into FBMS by Formulary Operations Specialists • Operationalize formulary information from Formulary Advisory Committee, Pharmacy and Therapeutics committee, Medi-span, and Account Management into the Formulary and Benefit Management System (FBMS) • Make independent decisions on formulary setup and maintenance when creating and building new formulary designs for custom clients • Coordinate formulary document creation and posting, including web, e-prescribing, formularies, change notifications, and medication program lists • Review, assign, and monitor Formulary Change Requests, New Client Formulary Implementations, operational formulary clean-ups, and project SME requests • Maintain P&Ps and standard work instructions around day-to-day work • Assist Formulary Operations Specialists with problem-solving and troubleshooting • Troubleshoot formulary and setup questions • Participate in meetings and committees as requested/assigned • Perform other duties as assigned

🎯 Requirements

• A minimum of a High School diploma plus specialized knowledge relating to PBM practice and business software applications is required • Pharmacy technician certification/experience is required, with additional education beyond high school strongly preferred • A minimum of 2-5 years of experience working with formulary information • Proven analytical, problem solving and written and verbal communication skills • Experience in PBM/Managed health care claims processing required • Must be comfortable communicating with vendors, outside and internal customers • Must have a working knowledge of pharmacy practice including drug names (brand vs. generic, NDC, GPI) and claims processing background (either from managed care or from community practice) • Familiarity with prescription drug formularies • Experience with maintenance of formulary setup and documents • Strong computer skills (Excel, Word, Outlook) • Participate in, adhere to, and support compliance program objectives • The ability to consistently interact cooperatively and respectfully with other employees

🏖️ Benefits

• Top of the industry benefits for Health, Dental, and Vision insurance • 20 days paid time off • 4 weeks 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 Professional Membership assistance • Referral Bonus Program – up to $750!

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