Hybrid Clinical Account Consultant – Pharmacy, Medicare Formulary Strategy

at Health Care Service Corporation

• Job title: Clinical Account Consultant – Pharmacy, Medicare Formulary Strategy
• Job type: Full Time
• Experience level: Mid level, Senior
• Salary: $102,000 - $184,300 per year
• Degree requirement: Professional Certificate
• Location requirements: Hybrid, Nashville, United States

About the role

• Clinical Account Consultant managing Medicare formulary strategy at HCSC. Collaborating with teams to develop and execute formulary strategies compliant with regulatory requirements.

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 Contracting departments
• Contributes to the annual Part D bid development by providing formulary files and assumptions, as well as documents required for P&T Committee review and approval
• Ensures complete modeling and evaluation of drug contract offers and act as drug manufacturer clinical point of contact
• Communicates changes to the PBM and ensures execution of formulary strategies
• Collaborates with the Coverage Determination (CD) unit to implement UM changes and develop decision trees for drugs with UM and select non-formulary drugs
• Partners with key stakeholders of formulary strategy outcomes and ensures collaboration to achieve goals
• Assists with formulary submission outlier review process
• Maintains formulary-related policies and procedures and job aids

Requirements

• Registered Pharmacist
• 4 years of managed care pharmacy experience or 4 years of consulting experience in the pharmacy benefits industry (completion of managed care residency can substitute for 4 years of managed care pharmacy experience requirements)
• Knowledge of pharmacy benefits products, services and concepts
• Analytical skills including developing reports and synthesizing data to tell a story and develop recommendations
• Written and verbal communications skills including developing presentations and presenting to external business leaders or large audiences
• Collaboration skills to work across organization on problem resolution, negotiation, consensus building, conflict management, and decision-making skills
• Relationship building skills to build strong customer relationships
• Project management skills and experience
• Experience with Microsoft Office applications (Word, Excel, PowerPoint) and clinical/business databases

Benefits

• Health and wellness benefits
• 401(k) savings plan
• Pension plan
• Paid time off
• Paid parental leave
• Disability insurance
• Supplemental life insurance
• Employee assistance program
• Paid holidays
• Tuition reimbursement
• Additional incentives