Formulary Operations Pharmacist

About Judi Health Judi Health is a health technology company providing benefit administration solutions to employers, unions, health plans, and government entities. Judi Health replaces fragmented, outdated systems with the industry's first Unified Claims Processing™ architecture, seamlessly consolidating pharmacy and medical benefit administration on a single, secure platform. By delivering true price transparency, eliminating unnecessary middleman fees, and leveraging advanced AI-powered care delivery, Judi Health helps clients achieve unprecedented operational efficiency and service levels. At Judi Health, we're deploying the infrastructure our country needs to deliver the healthcare we all deserve. We are the intelligence platform powering benefits plans for millions of Americans and proudly leading the next generation of care. To learn more, visit www.judi.health . Location: Hybrid (Local to New York, New York; Denver, Colorado; or Charlotte, North Carolina area)   Position Summary:   The Formulary Operations Pharmacist – Medicare is responsible for providing operational support for the evaluation, implementation, and maintenance of Medicare Part D formularies and utilization management. This individual supports creation and maintenance of formulary and utilization management lists, preparation of CMS formulary files and member formulary drug lists, preparation and review of updates for implementation, and other formulary and utilization management related tasks and processes. The role requires strong cross functional collaboration and communication skills, and an understanding of Medicare Part D formulary management processes and related CMS rules and regulations.  The position also  provide s   support   to  non-Medicare formulary  management  tasks as opportunities arise.   Position Responsibilities:   Maintain standard and custom formularies for the Medicare line of business in accordance with CMS Medicare guidelines   Supports the development, implementation, maintenance, and quality control of Medicare Part D formularies, utilization management, and clinical adjudication drug lists   Leads and supports the preparation of monthly and annual files for CMS formulary submissions, member formulary drug lists and look up tools, and utilization management criteria   Expanded scope of responsibilities across other non-Medicare business lines when needed, driving alignment, operational excellence, and strategic execution across diverse functions   Evaluate drugs and drug classes,  to provide formulary positioning and utilization management recommendations, and update formulary management strategies and associated adjudication requirements to operationalize   Evaluates the appropriateness of and operationalizes custom client formulary and benefit change requests within the formulary and adjudication platform   Creates customized marketing materials, including but not limited to member formulary drug lists, utilization management criteria documentation, and web-based look up tools   Supports the comprehensive testing of client formulary and benefit elections   Supports custom formulary client trade and rebate strategy evaluation   Identifies opportunities for automation and collaborates with Analytics to streamline processes and workflows   Analyzes pharmacy cost of care and clinical updates for the development of formulary management programs and utilization management edits   Provides clinical support to operational teams and clients during implementations   Serves as the clinical operations liaison to assist with ad-hoc sales requests and strategic communications for clients to provide expert insights from a clinical perspective   Quality assurance checks of Formulary Specialist activities, with emphasis on actions impacting adjudication of claims for accuracy   Provides cross functional support for claims troubleshooting within the adjudication platform   Monitors and analyzes regulatory and legislative requirements for Medicare   Leads and supports timely submission of all required reporting to State and Federal regulators, such as required formulary submissions to Health Plan Management System (HPMS)   Supports the development of project plans to meet new CMS requirements, and supports cross functional teams with implementation of programs to meet requirements   Leads formulary change processes within URAC/NCQA/CMS guidelines   Supports Pharmacy and Therapeutics (P&T) committee items, as required   Maintains and updates the Rx pharmaceutical pipeline, development of monthly newsletters, and other client communications as needed   Develops clinical criteria for review as needed   Supports CMS Program Audits as a formulary administration subject matter expert and provide necessary input of information to complete any auditor requested deliverables, including but not limited to root cause analysis, beneficiary impact analysis, and corrective action plans   Supports Quality Improvement projects, clinical value projects, and continuous improvement initiatives, as needed    Supports Request for Information (RFI) and Request for Proposal (RFP) submissions, as needed    Support general business needs and operations, as needed   Supports review of new regulatory guidance and regulations that impact formulary administration and provide guidance to internal and external stakeholders for compliant action   Maintains compliance with all regulatory and organizational deadlines   Responsible for adherence to the Judi Rx Code of Conduct including reporting of noncompliance   Performs other duties and responsibilities as needed     Minimum  Qualifications:   Doctor of Pharmacy (PharmD) Degree from an accredited institution   Current, unrestricted registered pharmacist license(s)   Residency/fellowship preferred   2+ years of Medicare formulary experience working for a health plan or PBM    Knowledge of formulary development and maintenance processes   Knowledge of highly managed specialty medications/strategy   Knowledge of rebate and financial implications of formulary strategies   Experience working with large datasets  required   Ability to independently identify, research, and resolve issues   Ability to balance multiple complex projects simultaneously   Ability to work extended hours, weekends, and holidays consistent with industry demands   Exceptional written and verbal communication skills   Extremely flexible, highly organized, and able to shift priorities easily   Attention to detail & commitment to delivering high quality work product   Proficient in Microsoft office suite with stong emphasis in Microsoft Excel  required   This range represents the low and high end of the anticipated base salary range. The actual base salary will depend on several factors such as: experience, knowledge, skills, and location of the job. Remote, US Salary Range $125,000 — $140,000 USD New York, NY Salary Range $125,000 — $140,000 USD Denver, CO Salary Range $125,000 — $140,000 USD Charlotte, NC Salary Range $125,000 — $140,000 USD All employees are responsible for adherence to the Judi Health Code of Conduct including the reporting of non-compliance. This position description is designed to be flexible, allowing management the opportunity to assign or reassign duties and responsibilities as needed to best meet organizational goals. We provide equal employment opportunities to all employees and applicants for employment and prohibit discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, medical condition, genetic information, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.   By submitting an application, you agree to the retention of your personal data for consideration for a future position at Judi Health. More details about Judi Health's privacy practices can be found at   https://www.judi.health/legal/privacy-policy .

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