Job Description
We are seeking a Formulary Operations Pharmacist to lead operational support for Medicare Part D formulary management and utilization oversight. This role encompasses the strategic evaluation, seamless implementation, and ongoing maintenance of formulary systems while ensuring compliance with CMS regulations. The successful candidate will drive formulary optimization, manage utilization management protocols, and collaborate across departments to deliver exceptional outcomes for Medicare beneficiaries.
- Salary is $125,000 - $135,000 Annually
Responsibilities:
Formulary Management & Compliance
- Oversee standard and customized formulary operations for Medicare products in full compliance with CMS guidelines and regulations
- Drive development, implementation, and quality assurance of Medicare Part D formularies, utilization management protocols, and clinical adjudication systems
- Coordinate preparation and submission of monthly and annual CMS formulary filings, member drug lists, and utilization management documentation
Strategic Drug Evaluation & Implementation
- Conduct comprehensive drug and drug class evaluations to inform formulary positioning and utilization management strategies
- Develop and refine formulary management approaches with corresponding adjudication requirements for operational deployment
- Assess and implement custom client formulary modifications and benefit adjustments within existing platforms
Quality Assurance & Testing
- Lead comprehensive testing protocols for client formulary configurations and benefit selections
- Provide cross-functional expertise for claims resolution and adjudication platform troubleshooting
- Support CMS formulary administration audits and ensure regulatory compliance
Regulatory & Legislative Oversight
- Monitor evolving Medicare regulatory and legislative landscape to ensure continued compliance
- Collaborate on project planning to address new CMS requirements and support cross-functional implementation teams
- Manage formulary change processes in accordance with URAC, NCQA, and CMS standards
Clinical & Committee Support
- Participate as ad hoc member of Pharmacy and Therapeutics (P&T) Committee
- Conduct systematic formulary reviews and prepare comprehensive drug monographs on rotating basis
- Maintain and enhance Capital Rx pharmaceutical pipeline as business needs evolve
- Develop evidence-based clinical criteria for formulary decisions
Business Development & Operations
- Contribute to Request for Information (RFI) and Request for Proposal (RFP) responses
- Support quality improvement initiatives and general business operations as needed
- Ensure adherence to Capital Rx Code of Conduct and report compliance concerns appropriately
Required Qualifications:
Education & Licensure
- Doctor of Pharmacy (PharmD) degree from ACPE-accredited institution with demonstrated academic excellence
- Current, unrestricted pharmacist license in good standing
- Post-graduate residency or fellowship training preferred
Professional Experience
- 2-3 years of formulary management experience within health plan or PBM environment preferred
- 2-3 years of Medicare-specific experience preferred
- Demonstrated expertise in formulary development and maintenance workflows
Technical Knowledge & Skills
- Deep understanding of specialty medication management and strategic oversight
- Medicare experience is required
- Knowledge of rebate structures and financial impact of formulary decisions
- Experience with large-scale data analysis and interpretation preferred
- Advanced proficiency in Microsoft Office Suite, particularly Excel
Core Competencies
- Independent problem-solving with strong research and analytical capabilities
- Exceptional project management skills with ability to handle multiple complex initiatives simultaneously
- Flexibility to work extended hours, weekends, and holidays as industry demands require
- Outstanding written and verbal communication abilities
- High degree of adaptability, organization, and priority management
- Meticulous attention to detail with unwavering commitment to quality deliverables
Clinical Resource Network Distinction CRN, a division of Solomon Page, offers a comprehensive benefits program for hourly employees. We pride ourselves on offering medical, dental, vision, 401(k), telehealth services, ESOP, and commuter benefits to our employees, including consultants - which sets us apart in the industries we serve.
About CRN Founded in 2002, Clinical Resource Network (CRN), a division of Solomon Page, provides clinical research and talent solutions for pharmaceutical, biotech, and medical device companies. Focused on forming long-term relationships, services encompass contract staffing, project staffing, consultative services, and full-time placements. For more information, visit https://www.solomonpage.com/crn and connect with us on Facebook and LinkedIn.
Opportunity Awaits. #LI-MB7
Job Tags
Hourly pay, Permanent employment, Full time, Long term contract, Work at office, Weekend work,