[Hiring] Formulary Lead @Navitus Health Solutions, LLC

Role Description

Due to growth, we are adding a Formulary Lead, Formulary Operations to our team! The Formulary Lead, Formulary Operations will perform the daily, weekly and monthly/periodic administrative functions relative to updating and maintaining the various formularies for Navitus clients. This includes all of the duties of the Formulary Operations Specialist II, plus responsibilities for triaging, assigning, and monitoring completion of work requests. The Formulary Operations Formulary Lead will work closely with internal Navitus teams to coordinate and operationalize all changes to the formulary including drug tiering and utilization management. Additionally, the Formulary Operations Formulary Lead will work with internal departments to ensure formulary resources are requested and allocated properly.

Responsibilities

• Research and coordinate approval with Formulary Operations Leadership all proposed FAC and P&T changes based on Navitus base setup, functionality of software and timelines for implementation.
• Communicate and document all approved FAC and P&T changes to internal teams and client groups for approval, including client responses.
• Provide detailed change spreadsheets outlining required formulary changes and client decisions from FAC and P&T for entry into FBMS by Formulary Operations Specialists.
• Operationalize formulary information from various sources including Formulary Advisory Committee, the Pharmacy and Therapeutics committee, Medi-span, and Account Management and coordinate the process of getting the information into the Formulary and Benefit Management System (FBMS).
• Make independent decisions on formulary setup and maintenance when creating and building new formulary designs for custom clients which directly affects the bottom line of our clients.
• Coordinate formulary document creation and posting, including maintenance of web, e-prescribing, formularies, change notifications, and medication program lists.
• Review, assign and monitor the following tasks with Specialists based on criteria developed by Formulary Operations Leadership:
  • Formulary Change Requests
  • New Client Formulary Implementations
  • Operational formulary clean-ups
  • Requests for Formulary Specialists as project SMEs
  • Maintain P&Ps and standard work instructions around day-to-day work
  • Assist Formulary Operations Specialists with problem-solving and troubleshooting
  • Trouble-shoot various formulary/set-up questions
• Participate in meetings and committees as requested/assigned.
• Other duties as assigned.

Qualifications

• A minimum of a High School diploma plus specialized knowledge relating to PBM practice and business software applications is required.
• Pharmacy technician certification/experience is required, with additional education beyond high school strongly preferred.
• A minimum of 2-5 years of experience working with formulary information.
• Proven analytical, problem solving and written and verbal communication skills.
• Experience in PBM/Managed health care claims processing required.
• Must be comfortable communicating with vendors, outside and internal customers.
• Must have a working knowledge of pharmacy practice including drug names (brand vs. generic, NDC, GPI) and claims processing background (either from managed care or from community practice).
• Familiarity with prescription drug formularies.
• Experience with maintenance of formulary setup and documents.
• Strong computer skills (Excel, Word, Outlook).
• Participate in, adhere to, and support compliance program objectives.
• The ability to consistently interact cooperatively and respectfully with other employees.

Benefits

• Top of the industry benefits for Health, Dental, and Vision insurance.
• 20 days paid time off.
• 4 weeks paid parental leave.
• 9 paid holidays.
• 401K company match of up to 5% - No vesting requirement.
• Adoption Assistance Program.
• Flexible Spending Account.
• Educational Assistance Plan and Professional Membership assistance.
• Referral Bonus Program – up to $750!