Pharmacy Technician, Formulary Management

Job Description

A bit about this role: 

As a Pharmacy Technician on the Formulary Management Team, you will perform oversight of various Part D formularies and contribute to drug specific evaluations and coverage recommendations by analyzing utilization patterns, monitoring new drug releases, and conducting comprehensive regulatory research to ensure CMS compliance. You will serve as a key contributor to ensure the overall success of our formulary management division to ensure that our members are well informed of all things related to pharmacy and formulary benefits.

Embracing technology and innovation, our dynamic team navigates Medicare rules and regulations while prioritizing exceptional member care. We’re looking for a certified pharmacy technician experienced in managed care specifically Part D/MAPD and who has had additional PBM collaboration relative to the administration of Part D and Part B pharmacy claims.  Additionally, having a strong overall drug knowledge coupled with analytical skills that can help proficiently navigate data and BI tools will be highly valued in candidates.

At Devoted Health, we're dedicated to providing personalized, coordinated care to every Medicare-eligible member, aligning with the care and support we'd want for our own families.  

Required skills and experience: 

• Nationally Certified Pharmacy Technician (CPhT) in good standing.

• Familiarity with drug products, both generic and brand names.

• 2+ years of experience with Medicare Part D operations (e.g. pharmacy help desk, utilization management, formulary management) at a Health Plan and/or PBM.

Desired skills and experience: 

• Proficiency with Google Sheets or Excel, including basic to intermediate formula knowledge.

• Strong analytical skills - you are confident making sense of operations through data, you can establish quantitative goals, and you can articulate a case from first principles.

• Experience utilizing business intelligence tools to interpret, analyze, and visualize data with a high degree of technological aptitude, preferred.

Responsibilities & Impact will include:

• Contribute to the development, implementation, maintenance, and evaluation of formularies, ensuring adherence to CMS rules and state-specific regulations.

• Collaborate across departments to analyze data influencing pharmacy benefits, tier placements, and excluded drug coverage decisions.

• Conduct detailed analysis of various data points alongside clinical pharmacists to assess drugs for formulary placement.

• Coordinate the review of formulary and utilization management recommendations with finance and other relevant departments as needed.

• Assist in preparing timely formulary submission files and CMS submissions via HPMS.

• Oversee change notification processes and drug file maintenance to uphold accuracy and operational efficiency.

• Provide clinical expertise and support to internal teams and members, acting as a go-to resource for formulary-related inquiries.

• Effectively communicate formulary changes and updates to internal and external stakeholders.

• Support the creation of the user interface and offer expertise for the online formulary search tool.

• Perform quality assurance checks on formulary submissions, bid submissions, formulary documents, and other documents as assigned.

• Review and validate claims testing outputs to ensure coding accurately reflects the clinical intent of formulary design as needed.

• Manage and maintain accuracy in published formulary documents on the website.

• Create, implement, and maintain policies and procedures for effective formulary management.

• Perform regulatory plan document reviews as a pharmacy benefit Subject Matter Expert (SME) for EOC, Summary of Benefits, ANOCs, LIS Riders, etc.

• Manage the clinical pharmacy inbox, responding to any inquiries from external partners and triaging emails to business owners.

• Review overrides entered by the pharmacy team for accuracy and ensure they follow the internal override policy.

• Develop and maintain internal knowledge resources.

• Assist in various ad-hoc projects and responsibilities as needed to support the fu