Clinical Account Consultant Pharmacy - Medicare Formulary Strategy

Job description

At HCSC, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers. Join HCSC and be part of a purpose-driven company that will invest in your professional development. Job Summary: The Clinical Acct Consult Pharmacy - Medicare Formulary Strategy is responsible for multiple aspects of the development and execution of Medicare Part D formulary strategy in accordance with CMS 42 C.F.R. §423.100, 120 Prescription Drug Benefit Manual Chapter 6- “Part D Drugs and Formulary Requirements” to ensure the health plan’s formularies meet regulatory requirements and HCSC goals. Key Duties and Responsibilities: - Contributes to daily, monthly, and annual formulary development activities - Leads and/or supports Medicare internal formulary development subcommittee discussions and ensures appropriate execution of decisions - Develops and updates formulary utilization management (UM) criteria: prior authorization (PA), step therapy (ST), and quantity limits (QL) - Assists in development of annual formularies in collaboration with the Product, Actuary and Contrac...