Manager, Formulary Management - PBM Kroger Prescription Plans

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.

• 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

• 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

• Supervise and coach direct reports in the performance of their duties; complete performance reviews and provide feedback to direct reports

• Must be able to perform the essential job functions of this position with or without reasonable accommodation

Qualifications

• Bachelor's Degree in Pharmacy, Master's Degree

• 2+ years of clinical experience, or clinical or managed care pharmacy practice residency

• Pharmacist License

• Ability to work both independently and as part of a team

• Excellent oral/written communication skills

• Proficient in Microsoft Office

• Strong analytical and problem-solving skills

• Exceptional clinical skills and ability to apply sound clinical judgment to a variety of situations

• Proficiency in drug literature and clinical trial evaluation, including proficiency with electronic databases

• 5+ years of experience in pharmacy, managed care, or PBM

• 2+ years of experience in a leadership role

• Any experience in leading Pharmacy & Therapeutics, clinical policy, drug evaluation, and formulary management

• Knowledge of PBM industry, formulary management, pharmacy claims and managed care principles and practices

• Sr. Manager, Clinical Services and Operations

• Senior Vice President, KPP

• Health and Wellness, Division Merchandiser

Additional Information

All your information will be kept confidential according to EEO guidelines.