Manager Formulary Design and Strategy

Job Summary:

The Manager, Formulary Design & Strategy leads the creation of formulary design best practices and industry-leading, market-competitive formulary management strategies across all CareSource lines of business and markets.

Essential Functions:

• 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 Mangers 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
• Perform any other job duties as requested

Education and Experience:

• 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, to include 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

Competencies, Knowledge and Skills:

• Proficiency in Microsoft Word and Outlook and advanced proficiency in PowerPoint and Excel
• Strong presentation skills and ability to interact effectively with internal/external audiences, summarize work for different audiences
• Strong problem solving skills
• Familiarity with medical terminology
• Extraordinary attention to detail
• Ability to synthesize large amounts of findings orally and in writing
• Excellent time management and ability to effectively, efficiently and accurately manage multiple tasks simultaneously under tight timelines in a fast-paced healthcare environment
• Proven track record of creative or “out of the box” thinking
• Ability to work independently and within a team environment
• Strong oral, written, and interpersonal communication skills
• Excellent leadership, management and supervisory skills
• Energetic, enthusiastic, and politically astute
• Ability to act with diplomacy and sensitivity to cultural diversity
• Responsive to a changing environment
• Strategic management skills
• Conflict resolution skills
• Strong decision making skills
• Customer service skills with the ability to interact professionally and effectively with members, providers, internal business areas and colleagues
• Strong analytical skills with the ability to create reports and interpret operational, utilization and financial data
• Proven problem-solving skills with the ability to look for root causes and develop implementable, workable solutions

Licensure and Certification:

• Unrestricted registered pharmacist (RPh) Licensure is required

Working Conditions:

• General office environment; may be required to sit or stand for extended periods of time

Compensation Range:

CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.

Compensation Type (hourly/salary):

Organization Level Competencies

• Create an Inclusive Environment

• Cultivate Partnerships

• Develop Self and Others

• Drive Execution

• Influence Others

• Pursue Personal Excellence

• Understand the Business