Specialist II, Formulary Operations

Role Description

Due to growth, we are adding a Specialist II, Formulary Operations to our team! The Specialist II, Formulary Operations will perform the daily, weekly, and monthly/periodic administrative functions relative to updating and maintaining the various formularies for Navitus’ clients. This includes all the duties of the Specialist II, Formulary Operations I, plus making decisions on how formularies are built and maintained in the claims processing system which directly affects the financial performance of our services to our clients, their bottom line, and the retention of the Navitus client base. The Specialist II, Formulary Operations will work closely with the Navitus Benefit Systems Architects (BSAs) and the Navitus clinical team to coordinate and operationalize all changes to the formulary including drug tiering and utilization edits such as step therapy and quantity limits.

Responsibilities

• Operationalize formulary information from various sources including FAC, P&T, Medispan and CAEs to coordinate the process of getting the information into the Formulary and Benefit Management System (FBMS) and then communicated to Benefits Systems and Auditing.
• Coordinate implementation schedule of new clients.
• Work with implementation team to streamline process for new client implementations.
• Coordinate creating and building of unique formulary designs for custom clients.
• Make independent decisions on formulary setup and maintenance when creating and building new formulary designs for custom clients which directly affects the bottom line of our clients.
• Coordinate formulary document creation and posting, including maintenance of web, e-prescribing, formularies, change notifications, and medication program lists.
• Trouble-shoot various formulary/set-up questions.
• Review weekly Medispan Reports for specific changes that would affect the formulary.
• Approximate travel required (5-10%).
• Other duties as assigned.

Qualifications

• A minimum of a High School diploma plus specialized knowledge relating to pharmacy practice and business software applications is required.
• CPhT certification and experience as a pharmacy technician is required.
• 2-5 years’ experience working with formulary information; proven analytical, problem solving and written and verbal communication skills.
• Experience in PBM / Managed health care claims processing strongly preferred.
• Proficient in Word and Excel.
• Must be comfortable communicating with vendors, outside and internal customers.
• Must have a working knowledge of pharmacy practice including drug names (brand vs. generic, NDC, GPI) and claims processing background (either from managed care or from community practice).
• Experience with maintenance of formulary setup and documents.
• Participate in, adhere to, and support compliance program objectives.
• The ability to consistently interact cooperatively and respectfully with other employees.

Benefits

• Top of the industry benefits for Health, Dental, and Vision insurance.
• 20 days paid time off.
• 4 weeks paid parental leave.
• 9 paid holidays.
• 401K company match of up to 5% - No vesting requirement.
• Adoption Assistance Program.
• Flexible Spending Account.
• Educational Assistance Plan and Professional Membership assistance.
• Referral Bonus Program – up to $750!