Formulary Operations Manager

Summary

Join Oscar as a Manager, Formulary Operations and oversee internal formulary management operations, ensuring appropriate oversight when tasks are delegated to third parties. Partner with the Sr. Manager to monitor existing operations and strategize future changes. Collaborate with internal stakeholders to execute tasks maintaining formulary business operations. This role requires a blended work culture with a minimum of two days per week in the office (if within commuting distance of NYC, Tempe, or LA offices) otherwise remote work is acceptable. The base pay is $144,000-$189,000 per year, plus benefits and bonuses. The position requires a PharmD and significant experience in clinical pharmacy operations and formulary management.

Requirements

• Doctor of Pharmacy degree (PharmD)
• 3+ years working for PBM or Payer in clinical pharmacy operations
• 3+ years leading cross-functional teams/projects and change management
• 3+ years supporting formulary management (P&T Committee, clinical policy development, formulary run operations)

Responsibilities

• Ensure clinical quality standards are met by maintaining clinical policies used for decision-making
• Ensure that compliance standards set by regulators and NCQA are defined in policies, that procedures are documented, and that those processes audited
• Operationalize, develop and maintain a clinically appropriate and cost-effective formulary and medical benefit preferred drug list by operating and managing Oscar’s P&T committee, which includes evaluating new developments in the drug treatment landscape and providing recommendations on how to manage new to market drugs and new drug indications
• Provide written recommendations with responses and corresponding documentation for regulatory inquiries, feedback on future legislation, and other business questions that probe at formulary operations
• Responsible for annual formulary binder filings
• Accountable and responsible for maintaining mental health parity NQTL responses and working cross-functionally for future filings and responding to ongoing objections during the audit process
• Compliance with all applicable laws and regulations
• Other duties as assigned

Preferred Qualifications

• Residency Training
• Experience with Marketplace Exchange

Benefits

• Medical, dental, and vision benefits
• 11 paid holidays
• Paid sick time
• Paid parental leave
• 401(k) plan participation
• Life and disability insurance
• Paid wellness time and reimbursements
• Annual performance bonuses
• Oscar's unlimited vacation program