Manager, Formulary Operations

Posted about 1 month agoViewed

💎 Seniority level: Manager, 3+ years

📍 Location: Alabama, Arizona, Arkansas, California, Colorado, Connecticut, Florida, Georgia, Illinois, Indiana, Iowa, Kansas, Kentucky, Maine, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Oregon, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas, Utah, Vermont, Virginia, Washington, or Washington, D.C.

💸 Salary: 144000.0 - 189000.0 USD per year

🔍 Industry: Health Insurance

🏢 Company: Oscar Health👥 1001-5000💰 $140,000,000 Private over 4 years ago🫂 Last layoff almost 5 years agoHealth Insurance InsurTech Insurance Health Care

🗣️ Languages: English

⏳ Experience: 3+ years

🪄 Skills: Project ManagementHR ManagementCross-functional Team LeadershipBusiness OperationsAnalytical SkillsNegotiationWritten communicationComplianceRisk ManagementProcess improvementFinancial analysisData managementChange ManagementBudget management

Requirements:

Doctor of Pharmacy degree (PharmD)
3+ years working for PBM or Payer in clinical pharmacy operations
3+ years leading cross-functional teams/projects and change management
3+ years supporting formulary management (P&T Committee, clinical policy development, formulary run operations)

Responsibilities:

Ensuring clinical quality standards are met by maintaining clinical policies used for decision-making; ensure that compliance standards set by regulators and NCQA are defined in policies, that procedures are documented, and that those processes audited.
Operationalize, develop and maintain a clinically appropriate and cost-effective formulary and medical benefit preferred drug list
Provide written recommendations with responses and corresponding documentation for regulatory inquiries, feedback on future legislation, and other business questions that probe at formulary operations.
Responsible for annual formulary binder filings
Accountable and responsible for maintaining mental health parity NQTL responses and working cross-functionally for future filings and responding to ongoing objections during the audit process.
Compliance with all applicable laws and regulations
Other duties as assigned

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