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Aetna Medicare Part D Formulary/Operations Pharmacist in San Antonio, Texas

Req ID: 68045BR

Job Description

This role is full time telework, all locations considered.

This position reports to the Director of Clinical Policy and Formulary Compliance. The Pharmacy Service Manager will be responsible for operationalizing the Medicare Part D strategy. This includes from formulary creation during the bid period, through implementation, administration and oversight of the formulary during the monthly maintenance of business. In addition, the Pharmacy Service Manager will be responsible for assisting with Formulary strategy including utilization management creation and maintenance.

Fundamental Components included but are not limited to:

Ability to think analytically to identify an issue, identify a solution with little impact to members and both internal and external teams.

--Serve as a subject matter expert for Medicare Part D rules and regulations specifically related to formulary, transition fill, and drug requirements.

-Ability to lead meetings with both internal and external partners to collaborate towards a common goal, often requiring root cause and problem solving.

-Maintain a working knowledge of new and novel drugs in the pipeline and ability to assist with creating utilization management strategies based on clinical developments.

-Ability to work in a high-paced, timeline driven environment

-Ability to understand how decisions made related to the formulary with impact claims adjudication and hence beneficiaries.

-Understanding of CMS formulary process, monthly Formulary Reference Files, Annual Bid Process, mid-year change process

-Ability to present reports, training etc. to leadership, internal and external partners at conferences etc.

-Excellent written and spoken communications

-Superior attention to detail

  • Participate in market meetings to review utilization metrics and make recommendations as appropriate.

  • Serve as a subject matter expert and clinical liaison at internal committees.

  • Perform other duties as required.

Qualifications Requirements and Preferences:

  • Current unrestricted pharmacist license is required

  • 3+ years of pharmacy experience in a Medicare Managed Care environment required

  • Excellent communication and presentation skills required

  • General knowledge of Microsoft Excel is required

  • Analytical thinking and superior attention to detail required

  • Experience in Medicare Part D Clinical Operations and/or Medicare Part D Formulary preferred

  • Knowledge of clinical programs, and formulary designs. preferred

  • Understanding of medical and pharmacy terminology preferred

  • Experience working in Matrix Organization, Project management experience, ability to complete projects independently within very tight established timeframes preferred.

Licenses/Certifications:

Pharmacy - Licensed Pharmacist

Required Skills:

General Business - Applying Reasoned Judgment, General Business - Communicating for Impact, Leadership - Collaborating for Results

Benefit Eligibility

Benefit eligibility may vary by position.

Job Function: Healthcare

Aetna is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected Veterans status.

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