Head of Formulary and Utilization Management (Pharmacy) - VIRTUAL - Full-time / Part-time

POSITION SUMMARY

Head of Formulary and Utilization Management (Pharmacy)

OPEN TO WORK REMOTE ACROSS THE USA

Fundamental Components:

The position leads development, management and maintenance of Medicare Part D formularies for both PDP and MAPD products. Leading a team of pharmacists, this position is responsible for development of formulary strategies and utilization management programs to ensure competitiveness of our Medicare products and effective management of utilization. The position works with the formulary administration team to create formularies for annual CMS filing, monthly updates and ongoing maintenance to support multiple lines of business. In addition, this position will also play a key role in clinical policy development for Medicare Part D, support product specific needs through P&T and criteria council. In depth knowledge of CMS HPMS submission process, Medicare Part D chapter 6 along with other regulatory requirements regarding a Part D formulary and implementation is required.

Further, this position will lead the overall utilization management strategy through working collaboratively across the heavily matrix organization. This requires working with our manufacturer contracting unit, network management, finance and actuary to develop key strategies to drive cost effectiveness of care. Strong communication skill is required and prior proven record of success across multiple organizations is highly desired. People management experience is desired.

BACKGROUND/EXPERIENCE desired:

In-depth knowledge and experience in managed care / managed pharmacy / competitive environment.

5+ years administrative experience.

EDUCATION

The highest level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.

LICENSES AND CERTIFICATIONS

Pharmacy/Registered Pharmacist is desired

FUNCTIONAL EXPERIENCES

Functional - Information Management/Data acquisition, data management, programming and documentation/1-3 Years

Functional - Project Management/Cross-functional project management/1-3 Years

Functional - Medical Management/Medical Management - Pharmacy/1-3 Years

TECHNOLOGY EXPERIENCES

Technical - Desktop Tools/TE Microsoft Excel/1-3 Years/End User

REQUIRED SKILLS

Benefits Management/Promoting Health Information Technology/ADVANCED

General Business/Maximizing Work Practices/MASTERY

Leadership/Collaborating for Results/ADVANCED

DESIRED SKILLS

Benefits Management/Maximizing Healthcare Quality/MASTERY

Finance/Profit and Quality Vigilance/ADVANCED

Service/Improving constituent-focused Processes/MASTERY

ADDITIONAL JOB INFORMATION

Aetna is about more than just doing a job. This is our opportunity to re-shape healthcare for America and across the globe. We are developing solutions to improve the quality and affordability of healthcare. What we do will benefit generations to come.

We care about each other, our customers and our communities. We are inspired to make a difference, and we are committed to integrity and excellence.

Together we will empower people to live healthier lives.

Aetna is an equal opportunity & affirmative action employer. All qualified applicants will receive consideration for employment regardless of personal characteristics or status. We take affirmative action to recruit, select and develop women, people of color, veterans and individuals with disabilities.

We are a company built on excellence. We have a culture that values growth, achievement and diversity and a workplace where your voice can be heard.

We conduct pre-employment drug and background testing. Benefit eligibility may vary by position. Click here to review the benefits associated with this position.

Employment Type Regular Career Band Description Management