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Formulary Operations Manager

Department: Clinical Operations
Location: New York, NY

Location: Remote (For Non-Local) or Hybrid (Local to NYC area)

About Capital Rx:

Capital Rx is a full-service pharmacy benefit manager (PBM) and pharmacy benefit administrator (PBA), advancing our nation’s electronic healthcare infrastructure to improve drug price visibility and patient outcomes. As a Certified B Corp™, Capital Rx is executing its mission through the deployment of JUDI®, the company’s cloud-native enterprise health platform, and a Single-Ledger Model™, which increases visibility and reduces variability in drug prices. JUDI connects every aspect of the pharmacy ecosystem in one efficient, scalable platform, servicing millions of members for Medicare, Medicaid, and commercial plans. Together with its clients, Capital Rx is reimagining the administration of pharmacy benefits and rebuilding trust in healthcare.

Position Responsibilities:

  • Define, configure, and maintain standard and custom formularies for all lines of business including Commercial, Medicaid, Medicare Part D per CMS Medicare Part D guidelines and the Health Information Marketplace/Exchange
  • Provide client-facing strategic and operational support for the configuration, implementation, maintenance, and quality control of custom formularies, drug lists, custom formulary marketing materials, clinical adjudication lists, and utilization management edits
  • Evaluate appropriateness and operationalize custom client formulary and benefit requests within the formulary / adjudication platform
  • Collaborates with teams in a cross-functional environment including, but not limited to; benefit administration, client account management, analytics, software development/product, regulatory/compliance, government programs, member experience, prior authorization operations, and marketing
  • Develop weekly drug product review and formulary recommendations by assessing drug use trends, new drug releases, and review of primary literature
  • Analyze pharmacy cost of care, clinical updates, and coordinate the development of appropriate formulary management programs and utilization management edits
  • Set criteria for medication analysis and coordinate methodology for client requested and regulatory formulary reporting requirements
  • Support client drug information requests as needed
  • Evaluate drugs/drug classes and make formulary positioning and utilization management recommendations and formulary management strategies
  • Support quality improvement projects, as required
  • Support RFI and RFP submissions, as required
  • Support general business needs and operations, as required
  • Analytics experience managing large formulary data sets preferred

Required Qualifications:

  • Doctor of Pharmacy (PharmD) degree from an accredited institution required
  • Active, unrestricted registered pharmacist license (any state) required
  • Formulary development and maintenance experience in a managed care setting required
  • Experience with custom client benefit and formulary design preferred
  • Client facing/account management experience preferred
  • Residency/fellowship completion strongly preferred
  • Proficient in Microsoft office suite with emphasis on Microsoft excel
  • Experience working with large datasets preferred
  • Ability to balance multiple complex projects simultaneously
  • Exceptional written and verbal communication skills
  • Extremely flexible, highly organized, and able to shift priorities easily
  • High attention to detail and a self-starter
  • Commitment to delivering high quality work product

Base Salary: $105,000 - $145,000

This range represents the low and high end of the anticipated base salary range for the NY - based position. The actual base salary will depend on several factors such as: experience, knowledge, and skills, and if the location of the job changes.

Capital Rx values a diverse workplace and celebrates the diversity that each employee brings to the table. 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.

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