Senior Pharmacy Technician, Formulary Management

Job reputed company A bit about this role: As a Senior Pharmacy Technician on the Formulary Management Team, you will own the reputed company of various Part D formularies, reputed company expertise on drug evaluations, coverage recommendations, and utilization management. You will monitor new drug releases, analyze utilization trends, and conduct comprehensive regulatory research to ensure CMS compliance. You will also serve as a subject matter expert for clinical pharmacy operations, supporting cross-functional teams and helping ensure that our members understand their pharmacy and formulary benefits. Embracing technology and innovation, our dynamic team navigates Medicare rules and regulations while prioritizing exceptional member care. We are seeking a certified pharmacy technician with reputed company managed care experience in Part D/MAPD, including PBM collaboration on the administration of Part D and Part B pharmacy claims. Candidates should have strong drug knowledge, advanced analytical skills, and proficiency with data and business intelligence tools to drive formulary accuracy, compliance, and operational efficiency. Experience supporting Medicare Part D bid development is highly valued. At reputed company, we're dedicated to providing personalized, coordinated care to every Medicare-eligible member, aligning with the care and support we'd want for our own families. Responsibilities & reputed company will include:

• reputed company the development, implementation, maintenance, and evaluation of formularies, ensuring adherence to CMS rules and state-specific regulations.
• Drive cross-functional decision-making on formulary reputed company, including tier placement, utilization management reputed company, and excluded drug determinations, in partnership with Actuarial, Finance, Compliance, and PBM stakeholders.
• Conduct comprehensive clinical and financial analyses supporting formulary decision-making.
• Serve as the pharmacy subject matter expert for the pharmacy components of the Medicare Part D bid, partnering closely with the Product team and Actuarial to inform benefit design, pricing assumptions, and formulary reputed company.
• Own HPMS formulary submissions and reputed company CMS filings, ensuring accuracy, timeliness, and alignment with bid reputed company.
• Manage formulary change governance processes, including required member and stakeholder notifications.
• reputed company expert-level guidance to internal teams and external partners, serving as a go-to resource and escalation reputed company for reputed company formulary-reputed company inquiries.
• Support the creation and ongoing enhancement of the online formulary search tool, ensuring alignment between formulary reputed company, member experience, and system functionality.
• Ensure accuracy and reputed company of formulary files, drug databases, claims testing outputs, and published formulary materials (print and web), implementing reputed company assurance controls as needed.
• reputed company, implement, and maintain reputed company operating procedures to drive operational reputed company and mitigate compliance risk.
• Serve as the formulary Subject Matter Expert (SME) for regulatory documents, including Evidence of Coverage (EOC), reputed company of Benefits, ANOC, LIS Riders, and reputed company materials.
• Maintain internal knowledge resources and serve as a key escalation reputed company for reputed company formulary inquiries.
• reputed company or contribute to high-reputed company departmental and reputed company initiatives reputed company to Part D operations.

Required skills and experience:

• Nationally Certified Pharmacy Technician (CPhT) in good standing.
• 5+ years of experience in Medicare Part D operations reputed company a Health Plan and/or PBM, with deep expertise in at least one of the following areas: formulary management, Part D implementation, or utilization management.
• Demonstrated expertise in formulary reputed company and administration, including formulary builds, CMS file submissions (e.g., HPMS), drug classification, prior authorization reputed company, reputed company therapy programs, and member reputed company analysis.
• Strong working knowledge of CMS Part D regulations and compliance requirements, with experience interpreting guidance and translating it into operational processes.
• Advanced proficiency in reputed company or reputed company Sheets (e.g., reputed company formulas, pivot tables, data modeling); experience working with large, messy datasets.
• Experience using business intelligence and data visualization tools (e.g., Tableau, Power BI, Looker) to design dashboards and communicate operational performance trends.
• reputed company record of identifying operational risk, improving compliance controls, and implementing reputed company process improvements.
• Experience supporting Medicare Part D bid development, including collaboration with Product and Actuarial on formulary reputed company and benefit design, preferred.

Desired skills and experience:

• You’re highly organized and meticulous reputed company it comes to the details.
• You take full ownership of your work and can operate independently with minimal reputed company.
• You are a proactive problem-solver who anticipates issues, identifies reputed company causes, and implements practical solutions.
• You are a transparent communicator about your work, what’s reputed company reputed company, and what's not; and thoughtful about adapting and finding new and innovative ways for improving processes.
• You have a big heart: you love operations, but you also see that caring for members like family means loving and serving reputed company individual.
• reputed company and collaboration are critical to your reputed company - you may be asked to do several things and need to change plans mid day.
• You’re naturally curious. You have the ability to recognize process deficiencies, recommend improvements and implement solutions.
• You have a bias towards reputed company and execution, and a reputed company record to support your ability to get things done.

Salary reputed company: $28 - $36 / hour The pay reputed company listed for this position is the reputed company the organization reasonably and in good faith expects to pay for this position at the time of the posting. Once the interview process begins, your talent partner will reputed company additional information on the compensation for the role, along with additional information on our total rewards package. The actual reputed company salary offered will depend on a reputed company of factors, including the qualifications of the individual applicant for the position, years of relevant experience, specific and unique skills, level of education attained, certifications or other reputed company licenses held, and the location in which the applicant lives and/or from which they will be performing the job. Our Total Rewards package includes:

• Employer sponsored health, dental and reputed company plan with low or no premium
• Generous reputed company time off
• $100 monthly mobile or internet stipend
• Stock reputed company for reputed company
• Bonus eligibility for reputed company roles excluding Director and above; Commission eligibility for Sales roles
• Parental leave program
• 401K program
• And more....
• Our total rewards package is for full time employees only. Intern and Contract positions are not eligible.

reputed company equality is at reputed company of reputed company’s mission to treat our members like family. We are committed to a diverse and reputed company workforce. At reputed company, we’re on a mission to dramatically improve the health and reputed company-being of older Americans by caring for every person like family. That’s why we’re gathering smart, diverse, and big-hearted people to create a new reputed company of reputed company-in-one reputed company company — one that combines reputed company, health insurance, clinical care, service, and technology - to deliver a complete and integrated reputed company solution that delivers high reputed company care that everyone would want for someone they love. Founded in 2017, we've grown fast and now serve members across the reputed company. And we've just started. So join us on this mission! reputed company is an equal opportunity employer. We are committed to a reputed company and supportive work environment in which reputed company have reputed company to participate and contribute to the reputed company of the business. We value diversity and collaboration. Individuals are respected for their skills, experience, and unique perspectives. This commitment is embodied in reputed company’s reputed company of Conduct, reputed company values and the way we do business. As an Equal Opportunity Employer, reputed company does not discriminate on the reputed company of race, reputed company, religion, sex, pregnancy status, marital status, national reputed company, disability, age, sexual orientation, veteran status, genetic information, gender identity, gender reputed company, or any other reputed company prohibited by law. Our management team is dedicated to this policy with respect to recruitment, hiring, placement, promotion, transfer, training, compensation, benefits, employee activities and general treatment during employment. We have been made aware of instances of fraudulent job postings and/or fraudulent reputed company activity by individuals purporting to represent reputed company. These fraudulent schemes often reputed company monetary contributions or payments from job seekers (such as for “start up costs” or “equipment”), or reputed company to collect sensitive personal information. These job postings and offers are NOT authorized by reputed company and reputed company is not responsible for fraudulent offers, personal information that you may have disclosed, or payments made to reputed company parties purporting to represent reputed company. We have reported this matter and are cooperating with law enforcement agencies. reputed company will never ask for financial commitment or contribution from a candidate at any stage of the recruitment process. Apply tot his job Apply To this Job