Formulary Operations Specialist

Back to jobsFormulary Operations Specialist Charlotte, North Carolina, United States; Denver, Colorado, United States; New York, New York, United StatesApplyAbout Judi Health Judi Health is an enterprise health technology company providing a comprehensive suite of solutions for employers and health plans, including: Judi Rx, a public benefit corporation delivering full-service pharmacy benefit management (PBM) solutions to self-insured employers, Judi Health™, which offers full-service health benefit management solutions to employers, TPAs, and health plans, and Judi®, the industry’s leading proprietary Enterprise Health Platform (EHP), which consolidates all claim administration-related workflows in one scalable, secure platform. Together with our clients, we’re rebuilding trust in healthcare in the U.S. and deploying the infrastructure we need for the care we deserve. To learn more, visit www.judi.health.Position Responsibilities:   Supports the weekly, monthly, and quarterly maintenance and quality assurance checks of standard and custom formularies for all lines of business including Commercial, Medicaid, Medicare Part D, and the Health Information Marketplace  Assists the pharmacists in operationalizing nd implementing custom client formulary and benefit requests within the formulary management and adjudication platform  Triages and assists with Salesforce cases for custom formularies  Triages and monitors the Formulary Operations inbox  Uploads formulary composites in the adjudication platform and supports Benefits team testing by uploading adjudication data to applicable Salesforce cases  Assists the pharmacists with cross functional support for claim troubleshooting through the adjudication platform  Reviews formulary testing output templates for formulary accuracy  Supports the creation, maintenance, and validation of client and formulary marketing materials in the formulary management tool  Conducts adjudication system maintenance data entry activities  Inputs inactive to active NDC updates  Supplemental list updates in Medispan for pharmacists to perform quality checks  Creates non-formulary tier flips in the formulary management tool   Performs weekly formulary updates for Liberty, Freedom, and standard HIM formularies  Weekly moratorium updates, and weekly utilization management updates in the formulary management tool  Performs Monthly Specialty formulary updates in the formulary management tool  Provides support to Weekly New Drug to Market updates  Assists with creating job aids for Formulary Operations  Develops and maintains departmental SharePoint sites  Completes assigned work plan objectives and projects on a timely basis  Ensures quality assurance and formulary accuracy  Support quality improvement projects, as required  Support RFI and RFP submissions, as required  Support general business needs and operations, as required  Performs other duties and responsibilities as needed     Required Qualifications:  Registered Pharmacy Technician license   Certification from the National Pharmacy Technician Certification Board or National Health career Association or equivalent experience  3-4 years of pharmacy experience working for a health plan or PBM   Formulary development and maintenance process experience at a PBM or health plan including experience with custom client benefit and formulary design highly preferred  Proficient in Microsoft office suite with emphasis on Microsoft Excel including advanced Microsoft Excel functions, VBA, macros, etc.  Experience working with large datasets required  Knowledge of pharmacy claims processing drug names, and pharmacy/medical terminology  New York, NY Salary Range$70,000 - $85,000 USDDenver, CO Salary Range$70,000 - $85,000 USDCharlotte, NC Salary Range$70,000 - $85,000 USDAll employees are responsible for adherence to the Judi Health Code of Conduct including the reporting of non-compliance. This position description is designed to be flexible, allowing...