Company Statement
ConnectiCare is a leading health plan in the state of Connecticut. ConnectiCare’s mission is to make it easy for members to get the care they need. A local company for over 35 years, ConnectiCare has a full range of products and services for businesses, municipalities, individuals and those who are Medicare-eligible. A subsidiary of EmblemHealth, ConnectiCare leads the individual and small group markets in the state, and is ranked among the top commercial health plans in the nation, according to the National Committee for Quality Assurance.
We’re looking for individuals who want to make a difference in the communities we serve. If you want to join a local team and help change the way health care is delivered, ConnectiCare is the place for you.
Formulary Development Leader - Remote
Summary of Position
• Manage the formulary team. Ensure compliant formulary filings for Medicare, Medicaid, Commercial, HIX in NY and CT.
• Partner with PBM Clinical Account Executives to identify formulary improvement opportunities quarterly. Ensure weekly drug
changes are recorded and implemented accordingly.
• Oversee the operational execution of all clinical and formulary decisions, work with operations to test all formulary changes.
Principal Accountabilities
• Deliver the clinical and operational formulary needs of various lines of business such as Commercial, MCO, Medicare,
and Managed Medicaid.
• Responsible for the administration, communication and implementation of plan formularies.
• Perform drug reviews on new entities, update criteria, make recommendations regarding drug inclusion and utilization
management that will be used to create and maintain EmblemHealth’s formularies.
• Ensure pharmacy drug policies are current, accurate and approved by the Pharmacy & Therapeutics Committee.
• Partner with the PBM on all clinical implementations, interface with the pharmacy operations team to ensure
appropriate clinical claim processing, appropriate application of clinical rules at the point of sale.
• Ensure quality of the formulary by performing regular reviews of various available reports.
• Oversee and drive pharmacy formulary strategy implementation for the enterprise, including reviewing drug trends,
examining utilization management, competitor strategies, and working with internal groups (actuary, medical
economics, product, and ESI) to implement formulary strategies.
• Partner with the product teams to identify and implement opportunities for formulary decisions to reduce cost and
increase market competitiveness.
• Maintain strong collaborative partnerships with business partners.
• Manage the day to day functions of the Sr. Clinical Pharmacy Specialists ensuring all pharmacy drug changes are
implemented as required.
• Manage the team and the formulary calendar ensuring all state and federal submissions are timely and accurate.
• Identify process improvements and strategies to streamline the team's responsibilities and/or increase productivity.
• Update and maintain the team’s SOPs, procedures, and checklists.
• Report formulary compliance to senior leadership.
• Establish strong relationships with Pharma in support of identifying rebate and cost savings opportunities.
Education, Training, Licenses, Certifications
• Doctor of Pharmacy degree.
• PGY-1 or PGY-2 In Ambulatory Care, Geriatrics, Internal Medicine, or Managed Care Preferred
• Registered Pharmacist: New York State pharmacy license or eligible to obtain New York State license within 6 months
Relevant Work Experience, Knowledge, Skills, and Abilities
• A minimum of 10 years of relevant experience. (R)
• 5+ years of pharmacist experience. (R)
• Residency or 5 years’ clinical experience. (P)
• Knowledge of formulary utilization management techniques (R)
• Knowledge of pharmaceuticals and disease states to provide advice and consultation to providers and members, and
recommend changes to the formulary (R)
• Possess research and analytical skills sufficient to provide problem resolution and consultation to providers (R)
• Excellent verbal and written communication skills sufficient to prepare own correspondence and interact with members and
providers in provision of advice and guidelines (R)
EEOC Statement
We are committed to leveraging the diverse backgrounds, perspectives and experiences of our workforce to create opportunities for our people and our business. We are an equal opportunity/affirmative action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected veteran status or any other characteristic protected by law.