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Forest Home Universal Employee [Full Time]

BMC HealthNet Plan

Forest Home Universal Employee [Full Time]

National
Full Time
Paid
  • Responsibilities

    Reporting to the Director of Clinical Pharmacy, the Formulary Strategy Manager is primarily responsible for oversight and management of the Plan’s formularies for Medicaid and Commercial lines of business. The Formulary Strategy Manager, under the supervision of the Director is also responsible for utilizing broad understanding of managed care and PBM knowledge to develop, and/or implement strategies and programs to mitigate cost trend and improve health outcomes. The Formulary Strategy Manager’s work assignments involve conducting in-depth data analysis on drug utilization trends to evaluate and inform formulary strategies. The ideal candidate will play a critical role in leading transformative initiatives for the health plan pharmacy team: engaging key stakeholders, developing critical analysis, driving decisions, and implementing change. The Formulary Strategy Manager will work directly with the Director of Clinical Pharmacy, VP, and other leaders on a day-to-day basis.

     

    KEY FUNCTIONS/RESPONSIBILITIES:

    • Support the Director of Clinical Pharmacy and business leads (e.g. Formulary Management Clinical Pharmacist) in prioritizing and accelerating business opportunities (e.g. cost reduction and/or clinical outcome), developing critical analyses, engaging clinical and operational team members, and implementing change.
    • Participate with the clinical team in the development of formulary management strategies including recommendations for utilization management strategies and/or strategic placement of existing or new drugs on the formulary to maximize benefits based on market trends, rebate opportunities and or clinical guidelines.
    • Supports trend management by conducting rigorous analyses of drug spend, utilization, and/or approval scenarios for drugs managed on both the pharmacy and medical benefit in collaboration with finance and actuarial teams and the PBM partner.
    • Assist in the development of materials to be shared with JV partners, senior leadership and executive audiences.
    • Help ensure team achieves goals by providing project management support and/or leadership on key work streams for end-to-end implementation of projects.
    • Manage multiple projects simultaneously while meeting key deadlines and deliverables.
    • Makes decisions on moderately complex to complex issues regarding technical approach for project components, and exercises considerable latitude in determining objectives and approaches to assignments.
    • Demonstrate excellent communication skills including presentation, persuasion, and negotiation skills required working with coworkers and other stakeholders, including the ability to communicate effectively and remain calm and courteous under pressure.
    • Regular and reliable attendance is an essential function of the position.

     

    QUALIFICATIONS:

     

    Education:

    • Bachelor of Science or Bachelor of Arts from four-year college or university
    • Healthcare/Finance/Pharmacy B.A. or B.S preferred

    Experience:

    • 4-5 years of relevant experience is required

    Preferred/Desirable:

    • Prior strategy experience at a top-tier consulting firm, with experience developing and launching complex programs in a cross-functional environment OR prior finance experience
    • Prior Pharmacy business and operations experience (e.g. Managed care or PBM experience) a plus
    • Project management experience or certification

    Competencies, Skills, and Attributes:

    • Strong oral and written communication skills along with the ability to distill complex analysis and recommendations into succinct, persuasive executive presentations
    • Strong interpersonal skills and ability to interact within all levels of the organization as well as with external contacts
    • Able to work in a fast paced environment; ability to multi-task and manage multiple high priority projects simultaneously and prioritize to meet key deadlines without frequent formal check-in’s
    • Strong quantitative analysis and critical reasoning skills; ability to quickly break down complex problems and support findings with data
    • Relentlessly drives towards potential solutions, including moving to options B, C, D, and E when necessary; awareness of when to elevate issues to senior leadership when intervention is necessary
    • Passionate about contributing to an organization focused on continuously improving consumer experiences including providing the best health care to every person, regardless of her or his socioeconomic circumstances
    • Ability to perform in an environment with changing priorities

    WORKING CONDITIONS AND PHYSICAL EFFORT:

    • Occasional travel (<5%) may be required

     

    *Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability or protected veteran status.

    Required Skills Required Experience

  • Qualifications

    Required Skills: Courtesy, tact, and diplomacy are essential elements of the job.  Work involves much personal contact with others inside and/or outside the organization for purposes of giving or obtaining information, building relationships, or soliciting cooperation.

    Working knowledge of established teller procedures and policies.  Understanding of Credit Union operations.   Communicates information and ideas in speaking so others will understand.