Clinical Formulary Management Pharmacist - Remote

At Prime Therapeutics (Prime), we are a different kind of PBM, with a purpose beyond profits and a unique ability to connect care for those we serve. Looking for a purpose-driven career? Come build the future of pharmacy with us.

Job Posting Title

Job Description

The Formulary Pharmacist supports the clinical and operational formulary needs of multiple lines of business, including Managed Medicaid. This role evaluates new drugs and drug classes, develops formulary and utilization management recommendations, and supports Pharmacy and Therapeutics and other drug evaluation committees. The position implements and maintains formularies, criteria, adjudication, communications, and publications to ensure approved changes are accurately and consistently reflected.

Responsibilities

• Manage formularies and clinical criteria for claims adjudication, prescription drug lists, websites, and related publications in alignment with drug review committee decisions and client requests
• Participate in clinical and financial drug review committees; perform drug and class reviews and develop recommendations for formulary placement and utilization management criteria
• Research and explain clinical and business considerations related to drugs, drug classes, and formulary strategies, and provide subject matter expertise to resolve formulary issues
• Monitor weekly drug files for new products and apply appropriate drug statuses and formulary placement
• Perform routine formulary quality reviews using available reports and pharmacy data to identify and resolve discrepancies
• Develop and coordinate communications for members, clients, prescribers, pharmacies, and internal stakeholders regarding formulary changes
• Serve as a liaison among clinical, operational, technical, client, and publishing teams to support end-to-end formulary management
• Maintain committee documentation and action items, and develop team procedures, checklists, and operational best practices
• Other duties as assigned

Minimum Qualifications

• PharmD or Bachelor of Science Pharmacy degree

• 1 year of pharmacy experience in a retail, mail order, health plan, PBM, or similar setting as a pharmacist
• Current Pharmacist license to practice in the applicable state(s)

Must be eligible to work in the United States without the need for work visa or residency sponsorship

Additional Qualifications

• Knowledge of prescription drugs, disease states, therapeutic classes, formulary management techniques, prescription benefit designs, and current healthcare industry trends
• Strong project management, prioritization, and organizational skills in an environment with changing priorities and multiple concurrent assignments
• Ability to meet short turnaround times and manage deadline-driven work with minimal oversight
• Excellent written and verbal communication skills and ability to communicate clinical and business information to varied audiences
• Strong analytical and problem-solving skills with consistent attention to detail and quality
• Ability to work collaboratively across teams while independently managing day-to-day responsibilities
• Ability to quickly learn computer systems and software; proficiency in Microsoft Office Suite, including Word, Excel, and PowerPoint

Preferred Qualifications

• Experience with health plan, PBM, Managed Medicaid, formulary operations, drug review committees, or utilization management
• Experience with formulary adjudication, clinical criteria implementation, prescription drug list publishing, or pharmacy data analysis
• Experience with Microsoft Visio or Access

Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their job, and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures

Every employee must be able to perform the essential functions of the job and, if requested, reasonable accommodations will be made to enable employees with disabilities to perform the essential functions, absent undue hardship. In addition, Prime retains the right to change or assign other duties to this job

To review our Benefits, Incentives and Additional Compensation, visit our Benefits Page and click on the "Benefits at a glance" button for more detail (https://www.primetherapeutics.com/benefits).

Prime Therapeutics LLC is proud to be an equal opportunity and affirmative action employer. We encourage diverse candidates to apply, and all qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sex (including pregnancy), national origin, disability, age, veteran status, or any other legally protected class under federal, state, or local law.  

We welcome people of different backgrounds, experiences, abilities, and perspectives including qualified applicants with arrest and conviction records and any qualified applicants requiring reasonable accommodations in accordance with the law.

Prime Therapeutics LLC is a Tobacco-Free Workplace employer.

Positions will be posted for a minimum of five consecutive workdays.