• Formulary management including but not limited to activities such as adjudication, formulary decision making, and benefit determination.

• Respond to and resolve clinical inquiries from members, clients, providers, or pharmacies related to formulary options, therapeutic alternatives, and coverage determinations.

• Complete prior authorization requests for members through collaboration with PBM Pharmacy Technicians.

• Assist with developing and presenting drug monographs, executive summaries, therapeutic class reviews, and medication policies to Pharmacy & Therapeutics Committees.

• Coordinate with pharmacy claims processor to ensure formularies, clinical edits, and plan designs are implemented according to requirements.

• Utilize claims data to evaluate benefit design for inappropriate utilization and opportunities to improve outcomes and optimize drug spend.

Job Related Knowledge, Skills and Abilities (Competencies):

• Drug therapy knowledge (Dosage, indications, side effects, etc.)
• Contemporary medication use systems
• Drug information through written and verbal consults as well as monographs
• Interpersonal communication
• Excellent organizational skills
• Supervisory concepts (for indirect reports)
• Problem solving

• PBM operational experience
• Specialty pharmacy practice
• Pharmacy benefit design
• Pharmacy & Therapeutics Committee participation
• Medication policy development
• Pipeline development
• Project management skills
• Specialty Pharmacy certification