Responsible for clinical analysis and research activities related to the implementation and ongoing maintenance of formulary and utilization management programs. Key strategist responsible for ensuring all clients initiated, and internal clinical policy and new clinical policy implementation projects are accurately implemented and maintained. Responsible for oversight of Magellan Rx National P&T (Pharmacy and Therapeutics) and Therapeutic Assessment Committee (TAC), as well as key areas pertaining to PBM (Pharmacy Benefit Management) formulary strategy.
Serves 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.
Prepares and presents clinical business strategy plan.
Supports opportunities for new clinical products for the expansion and maximization of revenue growth.
Coordinates all National Pharmacy & Therapeutics (P & T) and Therapeutic Assessment Committee (TAC) activities.
Has leadership oversight of Pharmacy & Therapeutics (P&T) committee charter and membership.
Management oversight of the clinical team responsible for the implementation and maintenance of drug formularies, as well as utilization management algorithm/criteria input for Prior Authorization review. Provides strategic support and coaching to team members. Refines UM Clinical Development team; works to develop employee skills, evaluates performance and provides feedback, and oversees resolution of employee relations issues.
Represents capabilities in UM Clinical Development, Pharmacy & Therapeutics, therapeutic assessment, and formulary management and design in RFP inquiries and internal sales and marketing presentations.
Acts as Utilization Management Clinical Development business owner; represents business needs for departmental system applications; collaborates with client facing teams to execute on client requests that impact operational tools.
Partners with Benefit and Formulary Operations in test case requirements development and reviews for the quality testing of formulary updates and new utilization management programs.
PharmD - Doctor Of Pharmacy, State Licensure - Pharmacy, RPH - Registered Pharmacist - Pharmacy
7 or more years of experience in pharmacy, managed care or PBM
At least 2 years of experience in a leadership role.
Prefer experience in leading Pharmacy & Therapeutics, clinical policy, drug evaluation, and formulary management.
Magellan Health Services is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled
Internal Number: R00000021991
At Magellan Rx Management, we are a full-service pharmacy benefit manager (PBM) that expands beyond traditional core services to help our customers and members solve complex pharmacy challenges by connecting them to the people, technology and information they need to make smarter healthcare decisions.
We are leading the next evolution of PBMs with a value-driven approach that moves past the traditional volume-focused thinking to deliver true value-driven solutions, including:
•Targeted clinical programs
•Powerful member and provider engagement strategies
•Comprehensive specialty pharmacy management capabilities
As pioneers in managing specialty spend both on the prescription and medical benefit, we are effectively-positioned to continue delivering thought-leading solutions in this complex and rapidly growing area of healthcare to help people live healthier lives.
We believe in developing and executing smart solutions across the following lines of business:
•Employer, Third Party Administrator, Broker
•Government, Medicaid, Medicare Part D
Magellan Rx Management is a division of Magellan Health, Inc.