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Pharmacist- Medicare Part D Formulary Manager- 014962

Company: Excellus BlueCross BlueShield
Location: Utica
Posted on: June 4, 2021

Job Description:

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.

Essential Responsibilities/Accountabilities:

  • 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 guidance
  • 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 Management Team.
  • 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 tasks.
  • 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.

Minimum Qualifications:

  • 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 process experience.
  • 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, etc.
  • Ability to serve as a professional, articulate, and knowledgeable liaison regarding pharmacy benefits both externally and internally.
  • Excellent project management skills including the ability to manage multiple complex projects within time and budget constraints.
  • 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 exists.
  • Fundamental knowledge of Microsoft Office applications.

Physical Requirements:

  • 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 conferences.
  • 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 telephone.
  • 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.


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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