KPP/FORMULARY MANAGEMENT MANAGER
JOB DESCRIPTION
Responsible for clinical analysis and research activities related to the implementation and ongoing maintenance of formulary and utilization management programs. Ensure all clients initiated, and internal clinical policy and new clinical policy implementation projects are accurately implemented and maintained. Responsible for coordination of the Kroger Prescription Plans Pharmacy & Therapeutics (P&T), as well as key areas pertaining to Pharmacy Benefit Management (PBM) formulary strategy. Demonstrate the company's core values of respect, honesty, integrity, diversity, inclusion and safety.
RESPONSIBILITIES
- Serve as key clinical and formulary expert for the organization in leading the development and delivery of medication and pharmacy utilization programs in support of total drug solutions
- Support and provide input for clinical programs to encourage appropriate, high quality, cost effective drug therapy and identify opportunities for improvement in efficiency, accuracy, and appropriateness of the programs in place
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- Manage and participate in coverage determination process; review all requests which are not clearly approvable based on specified criteria (algorithms), making all final coverage denial determinations
- Monitor the quality and efficiency of the coverage determination process, including coverage criteria, denial language, and communication with prescribers
- Participate in core teams working on new clinical products for the expansion and maximization of revenue growth
- Develop and review guideline criteria for prior authorization and non-formulary drugs in support of P&T Committee function and pharmacy benefit design
- Provide support documentation and develop communication for the P&T and Formulary Strategy Committee (FSC) review process and decisions
- Represent capabilities in UM Clinical Development, P&T, therapeutic assessment, and formulary management and design in Request for Proposal (RFP) inquiries and internal sales and marketing presentations
- Evaluate drugs/drug classes and make formulary positioning and utilization management recommendations
- Monitor and analyze regulatory and legislative requirements, develop project plans to meet requirements and lead cross functional teams to implement programs to meet requirements
- Oversee the implementation and maintenance of drug formularies
- Facilitate communication to and education of clients, members, and internal staff regarding clinical daily issues and objectives, i.e., high impact/high interest drugs
- Must be able to perform the essential job functions of this position with or without reasonable accommodation
QUALIFICATIONS
Minimum
- Other Bachelor of Science Degree in Pharmacy and/or Doctor of Pharmacy Degree (Pharm.D.) from an accredited U.S. School of Pharmacy
- 2+ years of clinical experience, or clinical or managed care pharmacy practice residency
- Pharmacist License
- Exceptional clinical skills and ability to apply sound clinical judgment to a variety of situations
- Ability to work both independently and as part of a team
- Strong analytical and problem-solving skills
- Excellent oral/written communication skills
- Proficient in Microsoft Office
- Proficiency in drug literature and clinical trial evaluation, including proficiency with electronic databases
Desired
- Any experience in leading Pharmacy & Therapeutics, clinical policy, drug evaluation, and formulary management
- 2+ years of experience in a leadership role
- 5+ years of experience in pharmacy, managed care, or PBM
- Knowledge of PBM industry, formulary management, pharmacy claims and managed care principles and practices
Perks and Benefits
Health and Wellness
- Health Insurance
- Dental Insurance
- Mental Health Benefits
Parental Benefits
Work Flexibility
Office Life and Perks
Vacation and Time Off
Financial and Retirement
- 401(K)
- Pension
- Financial Counseling
Professional Development
- Leadership Training Program
- Tuition Reimbursement
- Promote From Within
Diversity and Inclusion
- Diversity, Equity, and Inclusion Program
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