Pharmacist- Medicare Part D Formulary Manager- 014962
Company: Excellus BlueCross BlueShield
Posted on: June 4, 2021
Under the guidance of assigned management this pharmacist
clinician is a program manager, who is responsible for all Medicare
Part D formulary creation and submissions, which includes criteria
development for the current and upcoming contract years. This
individual creates and executes the Medicare Part D formulary,
delivering value and quality to the Plan's Part D enrollees, while
ensuring the longevity of the Plan's Part D program.
- Develops and maintains the Part D formulary in collaboration
with strategic business partners, which include trade relations,
finance, and sales to maximize savings, ensure quality, and
minimize member disruption, while incorporating all CMS Part D
- Manages all CMS Part D Formulary requirements to ensure
deadlines are met. Works in conjunction with the vendor Pharmacy
Benefit Manager (PBM) and Formulary Management vendor to execute on
all formulary-related tasks.
- Collaborates with cross-functional management teams within the
organization to align and prioritize Medicare objectives across the
organization to ensure success within the framework of the Medicare
STARS ranking system and deliver value to enrollees. Creates and
operationalizes Medicare Part D criteria for all utilization
management requirements in alignment with the Utilization
- Obtains endorsement of the Medicare Part D formulary program
elements from the Pharmacy and Therapeutics Committee.
- Oversees the production of CMS formulary model materials in
partnership with Medicare Sales and Marketing. Works in conjunction
with the outside vendor as needed to complete all formulary-related
- Supports and educates inter-departmental staff (clinicians,
customer care, sales) and external customers (members, brokers)
with respect to Part D formulary, utilization management edits, and
CMS Part D program guidance, as appropriate. Reviews, formulates,
and executes corrective action plans in conjunction with Medicare
Compliance for all formulary-based findings. Supports and acts as
subject matter expert for CMS formulary-based audits.
- Consistently demonstrates high standards of integrity by
supporting the Lifetime Healthcare Companies' mission and values,
adhering to the Corporate Code of Conduct and leading to the
Lifetime Way values and beliefs.
- Maintains high regard for member privacy in accordance with the
corporate privacy policies and procedures.
- Regular and reliable attendance is expected and required.
- Performs other functions as assigned by management.
- Pharmacy Degree and NY State Licensure required with a minimum
of three years' experience in an organized health care setting or
in a practice environment with direct physician interaction,
clinical practice, data analysis and/or benefit interpretation
- Expertise and background with Federal and state regulatory
agencies (CMS, DOH, DFS, etc.) and/or accreditation agencies (NCQA,
BCBSA) is preferred, but not required. Experience in Medicare Part
D is strongly preferred.
- Attained sufficient proficiency, skills and expertise to manage
and be accountable for a specific area of business, such as
specialty drugs, Medicare drug, rebate management, audit functions,
- Ability to serve as a professional, articulate, and
knowledgeable liaison regarding pharmacy benefits both externally
- Excellent project management skills including the ability to
manage multiple complex projects within time and budget
- Strong problem-solving ability, coordinates, directs and leads
coworkers, recognizes problems using scientific and logical
thinking and evaluates solutions.
- Exercises good judgment and maintains composure and
professional demeanor in the face of high stress situations that
frequently include dealing with complex issues, aggressive and/or
abrasive behavior, and fast-paced decision making.
- Excellent analytical and business planning skills. Excellent
written and oral communication skills.
- Ability to deal professionally with all levels of staff and
management. Ability to bridge issues and promote cooperative
approach across multiple operating divisions.
- Capable of working independently and applying problem solving
and analytical abilities to situations where no precedent
- Fundamental knowledge of Microsoft Office applications.
- Normal office environment, some meetings after normal business
hours and may include some evenings. Availability by cell phone for
emergency contact, as needed.
- Some travel required to various sites or out of area for
- Significant amount of time spent using a keyboard, reading a
computer screen, reading and interpreting detailed reports,
attending meetings in person and over the phone, and talking on the
- Frequently working at fast work pace, with frequent variation
in tasks. At times responds to emergencies.
The Lifetime Healthcare Companies aims to attract the best
talent from diverse socioeconomic, cultural and experiential
backgrounds, to diversify our workforce and best reflect the
communities we serve. Our mission is to foster an environment where
diversity and inclusion are explicitly recognized as fundamental
parts of our organizational culture. We believe that diversity of
thought and background drives innovation which enables us to
provide leading-edge healthcare insurance and services. With that
mission in mind, we recruit the best candidates from all
communities, to diversify and strengthen our workforce.
OUR COMPANY CULTURE:
Employees are united by our Lifetime Way Values & Behaviors that
include compassion, pride, excellence, innovation and having fun!
We aim to be an employer of choice by valuing workforce diversity,
innovative thinking, employee development, and by offering
competitive compensation and benefits.
In support of the Americans with Disabilities Act, this job
description lists only those responsibilities and qualifications
deemed essential to the position.
Equal Opportunity Employer
Keywords: Excellus BlueCross BlueShield, Utica , Pharmacist- Medicare Part D Formulary Manager- 014962, Other , Utica, New York
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