Clinical Pharmacist, Formulary Services

Summary

Join Abarca, a healthcare revolutionizing company, as our Clinical Pharmacist for Formulary Services. You will develop and implement Medicare, Medicaid, and Exchange formulary programs, ensuring regulatory compliance. Responsibilities include resolving adjudication issues, conducting client demos, and leading configuration setups for new clients. You will also provide consultative support, manage workloads, and identify process improvement opportunities. This role requires collaboration with various teams and active participation in audits and clinical programs. The position offers a flexible hybrid work model (Puerto Rico location only) with on-call availability.

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
• 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

Responsibilities

• 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

Preferred Qualifications

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

Benefits

We are proud to offer a flexible hybrid work model which will require certain on-site work days (Puerto Rico Location Only)