Jefferson Health

Job Details

Working under minimal supervision, the Formulary Pharmacist is responsible for managing the medication formulary for all lines of business for Jefferson Health Plans. The Formulary pharmacist is responsible for developing, implementing, and administering formulary and clinical management programs to support health plan program (Medicare Part D, Commercial, etc.) utilization and financial goals in collaboration with pharmacy management. The incumbent uses clinical pharmacy expertise in creating, updating, and maintaining the JHP drug formularies for all lines of business. The Formulary pharmacist ensures plan compliance and provides clinical and operations support in collaboration with pharmacy management for planning, creating, maintaining, and reviewing Jefferson Health Plans Formularies, Prior Authorization criteria, Step Therapy criteria, and other utilization management restrictions.

Job Description

Essential Functions:

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Formulary responsibilities include but are not limited to: implementing utilization edits in collaboration with pharmacists, assessing current formularies to ensure appropriate prior authorizations, step therapies, quantity limits, age limits and DUR edits are in place and are consistent with regulatory requirements.
• In collaboration with the pharmacy team, prepare and present current clinical and regulatory issues at clinical team meetings.
• Based on recommendations from clinical meetings, prepare and present all formulary changes for all lines of business for Jefferson Health Plans Pharmacy and Therapeutics (P&T) committee
• Serve as the subject matter expert with regards to formulary information for all internal and external stakeholders.
• Perform formulary updates on member facing files and programs and ensure Communications receives necessary PDF documents for website posting according to regulatory requirements.
• In collaboration with the PBM, ensure formularies across all lines of business correlate with the maximum available manufacturer rebates while maintaining a high standard of care and lowest net cost strategies in alignment with company goals.
• Ensure coding with the PBM aligns with the pharmacy benefit design and is compliant with the approved formulary.
• Audit and provide ongoing oversight of all aspects of the JHP formulary and benefit design implemented by the PBM for regulatory compliance.
• Utilizing the formulary software program, maintain, develop and update member facing formulary drug searches and PDF files in compliance with regulatory specifications.
• Ensure clinical criteria are being reviewed by clinical pharmacists at least yearly or in the event of changes in guidelines. Assess new formulary or non-formulary medications and assign criteria to pharmacists with the assistance of the Manager, Pharmacy Regulations and Implementations and Director of Pharmacy.
• Review and update regulatory formulary files weekly (or as needed) to ensure JHP formularies are in compliance with different state and federal agencies.
• Ensure accurate submissions of formularies, including utilization management edits, prior authorizations, and step therapy criteria, in compliance with different regulatory agencies, including DHS, PID, NCQA, and CMS.
• Review, address and justify formulary and utilization management outliers from regulatory agencies within specified timeframes.
• Approve Medispan changes with the PBM and ensure member facing website is aligned with the updated changes.
• Create, revise, and improve policies, procedures, data and new programs pertaining to all lines of business and pharmacy programs. Ensure compliance with pharmacy law and all regulatory requirements associated with CMS, DOH, DHS, PID and NCQA.
• Research and analyze new pharmaceuticals or new indications for existing pharmaceuticals.
• Assure compliance with departmental policies and procedures and processes.
• Attend DHS Pharmacy and Therapeutics Committee and DUR Board meetings as JHP representative, as required.
• Will perform other duties as assigned.

Education and Experience:

• Required: Pharmacy degree from accredited school, Pharm. D. or BS Pharmacy
• Requires current licensure as a pharmacist in the State of Pennsylvania
• Required: 3 years clinical pharmacy experience
• Preferred: Completed managed care residency o
• managed care industry

Skills/Abilities:

• Experience with formulary management including regulatory compliance with different state and federal agencies (such as DHS, CMS, NCQA, PID)
• Excellent written and oral communication skills.
• Competency with Microsoft Office Suite including Word, Excel, PowerPoint skills and database knowledge
• Self-motivated and team player with ability to direct projects and assignments.
• Strong presentation ability

Work Shift

Workday Day (United States of America)

Worker Sub Type

Regular

Employee Entity

Health Partners Plans, Inc.

Primary Location Address

1101 Market, Philadelphia, Pennsylvania, United States of America

Nationally ranked, Jefferson, which is principally located in the greater Philadelphia region, Lehigh Valley and Northeastern Pennsylvania and southern New Jersey, is reimagining health care and higher education to create unparalleled value. Jefferson is more than 65,000 people strong, dedicated to providing the highest-quality, compassionate clinical care for patients; making our communities healthier and stronger; preparing tomorrow's professional leaders for 21st-century careers; and creating new knowledge through basic/programmatic, clinical and applied research. Thomas Jefferson University, home of Sidney Kimmel Medical College, Jefferson College of Nursing, and the Kanbar College of Design, Engineering and Commerce, dates back to 1824 and today comprises 10 colleges and three schools offering 200+ undergraduate and graduate programs to more than 8,300 students. Jefferson Health, nationally ranked as one of the top 15 not-for-profit health care systems in the country and the largest provider in the Philadelphia and Lehigh Valley areas, serves patients through millions of encounters each year at 32 hospitals campuses and more than 700 outpatient and urgent care locations throughout the region. Jefferson Health Plans is a not-for-profit managed health care organization providing a broad range of health coverage options in Pennsylvania and New Jersey for more than 35 years.

Jefferson is committed to providing equal educa­tional and employment opportunities for all persons without regard to age, race, color, religion, creed, sexual orientation, gender, gender identity, marital status, pregnancy, national origin, ancestry, citizenship, military status, veteran status, handicap or disability or any other protected group or status.

Benefits

Jefferson offers a comprehensive package of benefits for full-time and part-time colleagues, including medical (including prescription), supplemental insurance, dental, vision, life and AD&D insurance, short- and long-term disability, flexible spending accounts, retirement plans, tuition assistance, as well as voluntary benefits, which provide colleagues with access to group rates on insurance and discounts. Colleagues have access to tuition discounts at Thomas Jefferson University after one year of full time service or two years of part time service. All colleagues, including those who work less than part-time (including per diem colleagues, adjunct faculty, and Jeff Temps), have access to medical (including prescription) insurance.

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