Manager Formulary Design and Strategy

Job Summary: The Manager, Formulary Design & Strategy leads the creation of formulary design best practices and industry-leading, market-competitive formulary management strategies across all CareSource lines of business and markets. Essential Functions: • Manages the CareSource RXInnovations Value Assessment Committee including preparation of meeting materials and presentations, and education of stakeholders following committee meetings • Directs and ensures the efficient operational management of the formulary management team with emphasis on execution, outcomes, continual improvement and performance enhancement • Oversees the monitoring of and educates stakeholders on the drug development pipeline and strategies we will employ to appropriately manage new and existing drugs • Works with appropriate business partners to ensure accurate and timely implementation of formulary changes by PBM • Monitors the formulary change process to minimize member disruption but drive value and better member outcomes • Supports leadership in direct rebating decisions and negotiations in collaboration with pharmaceutical manufacturers • Creates, monitors, and reports monthly on key performance indicators (KPIs) related to formulary management, including but not limited to cost and member, provider and/or drug utilization • Ensures team collaboration with Clinical Program Mangers to create and improve programs that drive better member health outcomes • Leads the identification, quantification and measurement of total cost of care savings opportunities related to formulary management and other drug management techniques • Collaborates with other teams to communicate and educate members, providers, pharmacies, and internal business partners on formulary, prior authorizations, specialty drugs and other initiatives • Ensures regulatory and compliance guidelines are met for Medicaid, Medicare, Exchange and future lines of related to formulary management and the development of clinical policies and criteria • Develops policies, trainings, and procedures to ensure compliance with new and existing regulations and accreditation standards. • Analyzes data regularly to identify process improvement opportunities relating to formulary management, as well as clinical policy and criteria development • Accountable for motivating, hiring, training, coaching, professional development, succession planning, performance appraisals, and disciplinary actions of staff • Advises and precepts APPE students and residents • Participates in department and team initiatives and projects • Participates in relevant pharmacy research projects and educational programs • Perform any other job duties as requested Education and Experience: • Bachelor s Degree in Pharmacy or Pharmacy Degree (PharmD) required; Master s in Business Administration or related is preferred • Minimum of five (5) years of managed care experience required, to include minimum of two (2) years of formulary management experience • Experience participating in or leading a P&T, Value Assessment Committee, or Drug Utilization Review Board required • Previous management experience is required • Experience working with multiple lines of business (commercial or government lines of business (Medicare, Medicare, or Marketplace)) or multiple states is preferred • Experience with state-mandated formularies preferred Competencies, Knowledge and Skills: • Proficiency in Microsoft Word and Outlook and advanced proficiency in PowerPoint and Excel • Strong presentation skills and ability to interact effectively with internal/external audiences, summarize work for different audiences • Strong problem solving skills • Familiarity with medical terminology • Extraordinary attention to detail • Ability to synthesize large amounts of findings orally and in writing • Excellent time management and ability to effectively, efficiently and accurately manage multiple tasks simultaneously under tight timelines in a fast-paced healthcare environment • Proven track record of creative or out of the box thinking • Ability to work independently and within a team environment • Strong oral, written, and interpersonal communication skills • Excellent leadership, management and supervisory skills • Energetic, enthusiastic, and politically astute • Ability to act with diplomacy and sensitivity to cultural diversity • Responsive to a changing environment • Strategic management skills • Conflict resolution skills • Strong decision making skills • Customer service skills with the ability to interact professionally and effectively with members, providers, internal business areas and colleagues • Strong analytical skills with the ability to create reports and interpret operational, utilization and financial data • Proven problem-solving skills with the ability to look for root causes and develop implementable, workable solutions Licensure and Certification: • Unrestricted registered p...