Overview
The Clinical Formulary Pharmacist is responsible for providing operational support for the evaluation, creation, maintenance, and implementation of standard and custom Medicare Part D Formularies. In addition, this role will work on utilization management, drug lists, and preparation of CMS formulary files. This role will work with the team to ensure all Formulary Management and Drug Information tasks are managed and maintained in accordance with all applicable laws, regulations, standards, policies and procedures as defined by CMS.
Our Company
Founded in 1926, Maxor is a leading, independent pharmacy solutions platform that improves prescription drug affordability and outcomes. Over time, Maxor has built a unique and complementary suite of services and technology offerings that deliver clinical, financial and strategic value to patients, payors and providers across the pharmacy supply chain. Maxor has a proud heritage of growth and innovation earned over the decades. Amarillo, Texas is the legacy headquarters for Maxor, but our talent base is national. We operate pharmacies and other business operation sites across the United States with employees working from 44 states.
Why Maxor?
Pharmacies are essential to healthcare, with nearly 90% of the US population living within 5 miles of one and seeing their pharmacist an average of 12 times a year. Providing a positive patient experience is crucial to ensuring patients adhere to their therapies.
At Maxor, we recognize that our employees are our most valuable assets. We actively seek and retain talented professionals who are mission-driven to improve healthcare outcomes for patients. Our employees are essential to their own well-being, finding fulfillment in meaningful work, competitive compensation, diverse and inclusive teams, and limitless career possibilities.
With a workforce of 1,300+ and almost a century of pharmacy experience, we offer the stability of a Fortune 500 company and the energy and innovation of a startup. Our expertise and technology support the entire pharmacy ecosystem, but our impact goes beyond pharmacy services. We enable pharmacy care.
Responsibilities
Formulary and Compliance Management
- Assist in developing, preparing, and managing formularies, preferred drug lists, prior authorization criteria, and step therapy protocols in compliance with CMS Medicare Part D guidelines.
- Assist in developing, preparing, and managing formularies, preferred drug lists, prior authorization criteria, and step therapy protocols in compliance with CMS Medicare Part D guidelines.
- Support clinical and/or formulary compliance efforts for government programs such as Medicare Part D and Medicaid.
- Assist in formulary change analysis and disruption evaluation for the organization.
- Communicate formulary changes, recommendations, quantity limitations, and clinical initiatives internally (e.g., to systems, operations, account managers, customer service) and as directed.
- Support CMS formulary administration audits.
Reports and Analysis
- Contribute to the development of clinical, utilization management, ad hoc, and production reports and programs.
- Participate in formulary analyses, rebate evaluations, and pharmacoeconomic studies and initiatives.
- Prepare drug reviews, agendas, and required materials for Clinical Advisory Board (CAB) Committee meetings as assigned.
- Review new market drugs, assess their cost implications, and report findings to management, coordinating changes such as updates to new-to-market lists, prior authorization (PA) lists, and quantity limit lists.
- Review and maintain prior authorization criteria requests.
List Management and Documentation
- Generate, maintain, and distribute formulary alternative lists, maintenance drug lists, and new drug-to-market lists.
- Create and distribute Clinical Newsletters, Pipeline/Patent Expiration updates, and other relevant drug information.
Setup and Coordination
- Assist with plan setup, including formularies, quantity limits, and prior authorizations for online adjudication, while compiling drug coverage summaries.
- Coordinate drug recall outreach in collaboration with Clinical leaders and the Compliance department.
Communication and Collaboration
- Collaborate with plan medical directors and staff to develop and execute clinical initiatives.
- Work with internal and contracted clinical pharmacists to develop, implement, and coordinate educational materials and programs for physicians and patients.
Education and Participation
- Stay informed on current drug therapies, reactions, and interactions through professional literature, seminars, and affiliations.
- Participate in programs, committees, meetings, and other functions as required.
Qualifications
Education: Graduation from an accredited school of Pharmacy required. Must be licensed in, and in good standing, in the state of employment and any other states as required to perform job duties.
Experience:
- Doctor of Pharmacy (PharmD) from an accredited institution.
- Current unrestricted registered pharmacist license.
- 5+ years working for a Health Plan or PBM.
- 3+ years of Medicare experience.
- Formulary development and maintenance experience.
- Drug list creation experience preferred.
- Experience with custom benefit and formulary design preferred.
Knowledge, Skills and Abilities:
- Ability to organize, prioritize, and schedule work assignments.
- Ability to communicate effectively, both verbally and in writing.
- Strong computer skills with the ability to learn new software programs and applications
- Ability to clearly communicate medical information to professional practitioners and/or the general public.
- Ability to develop and maintain recordkeeping systems and procedures.
- Skill in examining and re-engineering operations and procedures, formulating policy, and developing and implementing new strategies and procedures.
WE OFFER
At Maxor, we foster a diverse and progressive culture that promotes a work-from-home model and a "dress-for-your-day" approach to work attire. Our team-oriented environment encourages collaboration and innovation.
We offer highly competitive compensation and comprehensive health benefits including:
- Comprehensive mental health and wellbeing resources
- Nationwide Blue Cross Blue Shield PPO with employee-friendly plan design, including a $850 individual annual medical deductible and $25 office visit copays, with low biweekly premiums
- Company-paid basic life/AD&D, short-term and long-term disability insurance
- Rx, dental, vision, other voluntary benefits, and FSA
- Employer-matched 401k Plan
- Industry-leading PTO plan
- And more!
Apply today at: https://www.maxor.com/careers/
Maxor is an EOE, including disability/vets
