Principal, Formulary Operations & Strategy

Posted 2 Days Ago
Be an Early Applicant
San Diego, CA
148K-273K Annually
Senior level
Healthtech • Pharmaceutical
The Role
The Principal Formulary Operations and Strategy provides strategic and operational guidance to the Formulary team, focusing on program development, compliance, and performance. This role involves advising on formulary management design, ensuring regulatory alignment, and collaborating on initiatives to enhance operational outcomes in healthcare services.
Summary Generated by Built In

Exemption Status:United States of America (Exempt)

$147,579 - $210,300 - $273,021

“Pay scale information is not necessarily reflective of actual compensation that may be earned, nor a promise of any specific pay for any selected candidate or employee, which is always dependent on actual experience, education, qualifications, and other factors. A full review of our comprehensive pay and benefits will be discussed at the offer stage with the selected candidate.”

This position is not eligible for Sponsorship.

MedImpact Healthcare Systems, Inc. is looking for extraordinary people to join our team!

Why join MedImpact? Because our success is dependent on you; innovative professionals with top notch skills who thrive on opportunity, high performance, and teamwork. We look for individuals who want to work on a team that cares about making a difference in the value of healthcare.

At MedImpact, we deliver leading edge pharmaceutical and technology related solutions that dramatically improve the value of health care. We provide superior outcomes to those we serve through innovative products, systems, and services that provide transparency and promote choice in decision making. Our vision is to set the standard in providing solutions that optimize satisfaction, service, cost, and quality in the healthcare industry. We are the premier Pharmacy Benefits Management solution!

Job Description

The Principal Formulary Operations and Strategy serves as a subject matter expert and operational advisor to the Formulary team in line with overall organizational goals and objectives. This position provides strategic, regulatory, and tactical advice and counsel to the Formulary Services Department and other departments that are involved with Formulary creation and maintenance. Advises the vision, design, and development of new programs and processes important to the success of formulary management at MedImpact.

Essential Duties and Responsibilities include the following. Other duties may be assigned.

 • Provides subject matter expertise for formulary platform development for internal and client users of the formulary system. Serves as a key formulary SME and advisor across all related areas including Formulary Process Automation, Prior Authorization, Rebates, Compliance and Drug Information areas. Assists the formulary team in key departmental and cross-departmental initiatives and projects as directed

• Supports Formulary leadership in the alignment of technical and regulatory operations between Formulary Services, Government Programs and Services, and other organizational areas as appropriate. Acts as key contributor to the overall design and development of the Medicare Part D program and enterprise formulary management programs. Provides formulary and business perspective and insight to Program functionality. Assists with the integration and coordination between formulary programs and overall Part D design and compliance

• Assists in priority projects, programs, or initiatives supportive of the development and operation of formulary activities. Ensures that Formulary Services meets or exceeds all client and CMS deliverables in a timely and quality fashion. Collaborates to establish compliant policies and procedure documentation for all formulary services

• Interfaces with the formulary technical team to develop infrastructure, tools and processes capable of rapid technical solutions under compressed timeframes to meet demands caused by sudden CMS or business changes.

Supervisory Responsibilities This position has no supervisory responsibilities. Qualifications To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Education and/or Experience Pharm. D from an accredited program; minimum of 10 years of related managed care experience and 8 years of Subject Matter Expertise (SME) in respective areas; or equivalent combination of education and experience.

Computer Skills

 Proficient in Microsoft Office Suite products, including Access, Visio, Excel, Word, and others.

Certificates, Licenses, Registrations

 Valid Registered Pharmacist license in the State of California or equivalent state.

Other Skills and Abilities

• Prior experience in PBM formulary setup and maintenance, relational and analytical database management programs, as well as familiarity with RxNorm, First DataBank and Medi-Span drug files required.

• Requires broad experience with overall formulary and PBM functions across all applicable business lines including commercial, Marketplace, Medicare, and Medicaid.

 • Requires prior experience with Medicare Part D and CMS formulary submission and maintenance processes.

• Requires strong working knowledge of PBM clients, operational departments, and internal business operations and ability to bridge departmental boundaries.

Competencies:

Reasoning Ability- Ability to define problems, collect and analyze data, establish facts, and draw valid conclusions. Ability to interpret an extensive variety of technical instructions in prose, mathematical, or diagram form and deal with several abstract and concrete variables.

Mathematical Skills - Ability to work with mathematical concepts such as probability and statistical inference, and fundamentals of plane and solid geometry and trigonometry. Ability to apply concepts such as fractions, percentages, ratios, and proportions to practical situations.

Language Skills - Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, or governmental regulations. Ability to write reports, business correspondence, and procedure manuals. Ability to effectively present information and respond to questions from groups of managers, clients, customers, and the general public. Competencies To perform the job successfully, an individual should demonstrate the following competencies:

Analytical - Synthesizes complex or diverse information; Collects and researches data; Uses intuition and experience to complement data; Designs workflows and procedures.

Business Acumen - Understands business implications of decisions; Displays orientation to profitability; Demonstrates knowledge of market and competition; Aligns work with strategic goals.

Oral Communication - Speaks clearly and persuasively in positive or negative situations; listens and gets clarification; Responds well to questions; Demonstrates group presentation skills; Participates in meetings.

Problem Solving - Identifies and resolves problems in a timely manner; Gathers and analyzes information skillfully; Develops alternative solutions; Works well in group problem solving situations; Uses reason even when dealing with emotional topics.

Project Management - Develops project plans; Coordinates projects; Communicates changes and progress; Completes projects on time and budget; Manages project team activities.

Strategic Thinking - Develops strategies to achieve organizational goals; Understands organization's strengths & weaknesses; Identifies external threats and opportunities; Adapts strategy to changing conditions.

Written Communication - Writes clearly and informatively; Edits work for spelling and grammar; Varies writing style to meet needs; Presents numerical data effectively; Able to read and interpret written information.

 Physical Demands- The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this Job, the employee is regularly required to sit and talk or listen. The employee is occasionally required to stand; walk; use hands to finger, handle, or feel and reach with hands and arms. The employee must occasionally lift and/or move up to 35 pounds. Work Environment The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The noise level in the work environment is usually moderate.

Working Hours - This is an exempt level position requiring the incumbent to work the hours required to fully accomplish job responsibilities and reasonable meet deadlines for work deliverables. The individual must have the flexibility to work beyond traditional hours and be able to work nights, weekends or on holidays as required. Work hours may be changed from time to time to meet the needs of the business.

Typical core business hours are Monday through Friday from 8:00am to 5:00pm.

Travel This position may require approximately 10% domestic travel and may require international travel in which case a valid passport and ability to leave the United States will be required.

The Perks:

  • Medical / Dental / Vision / Wellness Programs
  • Paid Time Off / Company Paid Holidays
  • Incentive Compensation
  • 401K with Company match
  • Life and Disability Insurance
  • Tuition Reimbursement
  • Employee Referral Bonus

To explore all that MedImpact has to offer, and the greatness you can bring to our teams, please submit your resume to www.medimpact.com/careers

MedImpact, is a privately-held pharmacy benefit manager (PBM) headquartered in San Diego,
California. Our solutions and services positively influence healthcare outcomes and expenditures, improving the position of our clients in the market. MedImpact offers high-value solutions to payers, providers and consumers of healthcare in the U.S. and foreign markets.

Equal Opportunity Employer, Male/Female/Disabilities/VeteransOSHA/ADA:

To perform this job successfully, the successful candidate must be able to perform each essential duty satisfactorily. The requirements listed are representative of the knowledge, skill, and/or ability required.
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Disclaimer:

The above
statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified.

The Company
San Diego, CA
1,400 Employees
On-site Workplace
Year Founded: 1989

What We Do

MedImpact, an independent, trend-focused pharmacy benefit manager (PBM), is the nation’s largest privately held PBM, serving health plans, self-funded employers and government entities. Our business model is unique. We focus on effectively managing client pharmacy benefits to promote Lower Cost and Better Care through One Source. Our model aligns us with our clients. We help promote prescribing of lower-net-cost, medically appropriate drugs with fulfillment at the most appropriate participating pharmacy providing competitive pricing, good value and high-quality service.

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