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October 22 2018

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Offer: Sr. Formulary Specialist:

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Sr. Formulary Specialist

EmblemHealthNew York, NY10/12/2018
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Job Description

Careers at EmblemHealth: For nine decades, EmblemHealth has been making quality health care accessible and affordable for New Yorkers, and helping to make life better in the communities we serve. Our employees are proud of that legacy and want to make health care better for everyone. Here we inspire success while helping employees build significant careers. We offer competitive health and welfare benefits, retirement benefits, and incentive pay plans. Join us for a compensateing practice.


• Responsible for development and maintenance activities for formularies on the following lines of business: Medicare Part D, Medicaid, Commercial, Healthcare Exchange.
• Use sound clinical judgment and expertise of State and Federal regulations to ensure compliance with regulatory and contractual obligations.

Accountabilities:* Evaluates and maintains formulary set-up located on clinical requirements, compliance with regulatory bodies, and P&T rules.
• Manages the Pharmacy & Therapeutic Committee/Formulary Management, including Step-Protocol Review, Non-Formulary Review, Subcommittee Management (Meetings/minutes), Drug Reviews, and Updates and Drug Policies, for all medications.
• Manages utilization management tools, including review and update of pharmacy and medical policies, and Criteria for Medical Necessity (CMN) reviews for all medications to ensure alignment with formulary intent.
• Maintains clinical tools utilized by pharmacy services for purpose of remaining up to date and compliant with current pharmacy policies.
• Serves as subject matter expert for all escalated clinical formulary related issues as well as for all formulary related internal and external audits.

Job Requirements

Requirements and expertise & expertise:

• Doctor of Pharmacy degree or Masters in Pharmacy from an accredited school of pharmacy with clinical and drug information practice required
• Registered Pharmacist: New York State pharmacy license or eligible to obtain New York State license required
• expertise of formulary utilization management practices required
• expertise of pharmaceuticals and disease states to provide advice and consultation to providers and members, and recommend changes to the formulary required
• Possess research and analytical expertise sufficient to provide problem resolution and consultation to providers requireExcellent verbal and written communication expertise sufficient to prepare own correspondence and interact with members and providers in provision of advice and guidelines requiredd
• A minimum of 10 years of significant practice preferred
• Residency or 5 years' clinical practice preferred
• expertise of formulary management preferred

Depending on factors such as business unit requirements, the nature of the position, cost and applicable laws and regulations, EmblemHealth may provide work visa sponsorship for certain positions.

We are committed to leveraging the diverse backgrounds, perspectives and practices of our workforce to create opportunities for our people and our business. We are an equal opportunity/affirmative action employer and all qualified candidates will receive consideration for employment without regard to race, color, religion, sex, national origin, discapability, protected veteran status or any other characteristic protected by law.

Job Snapshot

Employment Type Full-Time
Job Type Health Care
Education Graduate Degree
practice None
Manages Others No
Relocation No
Industry Managed Care
Required Travel Not Specified
Job ID 4533BRCBP

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Company Overview

The EmblemHealth story began 75 years ago with ideals rooted in a simple, yet pioneering vision: provide quality health insurance plans for working New Yorkers and their families. Our legacy companies-Group Health Incorporated (GHI) and the Health Insurance Plan of Greater New York (HIP)-did, and continue to do, just that. The GHI and HIP health plans administered by EmblemHealth are among the most innovative and flexible in the industry. Groups and individuals can choose from a variety of accredited PPO, EPO and HMO health plans, as well as prescription drug, dental and vision coverage. Our provider network is more robust than ever. Plan members get access to most of the tristate area's top doctors and other medical professionals. Our members can also make use of acute care hospitals and physicians with hospitals across all 50 states.

Contact Information

New York, NY


Job Category: Customer Service [ View All Customer Service Jobs ]
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Degree: Unspecified
Experience (year): Unspecified
Job Location: Other
Company Type Employer
Post Date: 10/12/2018 / Viewed 3 times
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