Clinical Pharmacist, Formulary Services

Abarca is igniting a revolution in healthcare. We built our company on the belief that with smarter technology we are redefining pharmacy benefits, but this is just the beginning.

Our Clinical Pharmacist for Formulary Services, you will be responsible for developing and implementing Medicare, Medicaid, and Exchange formulary programs while ensuring compliance with external regulatory guidelines. Independently resolve adjudication and processing issues, provide client-facing demos on the PBM configuration platform, and lead configuration setup for new client implementations and changes.

The fundamentals for the job...

• Develop and implement Medicare, Medicaid, and Exchange formulary programs.
• Stay current with external regulator guidelines to make timely adjustments to operations ensuring our processes follow the rules and regulations.
• Both independently perform as well as consult and advise the team through research and resolution of adjudication and processing issues including, identification of root cause, impact analysis determination and corrective action.
• Resolution & Ownership of project-based work as assigned.
• Perform client or prospect client facing to present demos around the PBM configuration platform.
• Primary support for configuration setup for new Medicare, Medicaid, Commercial and Employer client implementations, as well as configuration changes for existing clients.
• Provide consultative support to clients as well as internal teams.
• Monitor and distribute the workload assignment of the configuration team.
• Identify opportunities and solutions in inventory management that advance efficiency and standards for configuration.
• Collaborate and coordinate both within the configuration teams and with other business units to execute configuration as required.
• Manage client benefit operational calls, key client meetings and requests by capturing significant discussion topics and action items as well as sharing input and solutions to address client needs., considering Abarca's priorities.
• Continuously develop and maintain an in-depth understanding of Darwin (proprietary adjudication platform) system logics to ensure designs are configured to meet client requirements with accuracy.
• Take part in the Pharmacy & Therapeutics Committee preparing presentations and clinical recommendations for new drugs.
• Research and remain informed of current and emerging trends in formulary and benefit design.
• Actively participate in government and internal audits.
• Engage in CMS Medicare STAR initiatives and clinical programs, as well as Medicare Plan Finder and PDE processes.
• Lead the team through process improvement efforts and recommendations.
• Develop process documentation, including Policies and Procedures, to document Benefit Administration operational processes.
• Support training new team members in configuration setup and standardized quality procedures.

What we expect of you

The bold requirements...

• Doctoral Degree in Pharmacy.
• Current/Active Pharmacy License.
• 3+ years of experience with formulary management within clinical operations, and pharmacy benefit management.
• Experience working within clinical scenarios.
• Excellent oral and written communication skills.
• We are proud to offer a flexible hybrid work model which will require certain on-site work days (Puerto Rico Location Only).
• This position requires availability for on-call hours, including evenings, weekends, and holidays, to promptly address emergent issues or provide necessary support as dictated by operational demands.
• This position requires availability to work in a specified time zone, accommodating the business needs of our clients and team members based in the determined time zone.

Nice to have...

• Experience with pharmacy benefit management clinical operations and Medicare Part D.
• Master's Degree.

Physical requirements...

• Must be able to access and navigate each department at the organization's facilities.
• Sedentary work that primarily involves sitting/standing.

At Abarca we value and celebrate diversity. Diversity, equity, inclusion, and belonging are guiding principles of Abarca and ensure Abarca's workforce reflects the communities it serves. We are proud to provide equal employment opportunities to all employees and applicants for employment and prohibit discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, medical condition, genetic information, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.

Abarca Health LLC is an equal employment opportunity employer and participates in E-Verify. "Abarca Health LLC does not sponsor employment visas at this time".

The above description is not intended to limit the scope of the job or to exclude other duties not mentioned. It is not a final set of specifications for the position. It's simply meant to give readers an idea of what the role entails.

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