• Job Description

  Req#: R1694

  At Devoted Health, we’re on a mission to dramatically improve the health and well-being of older Americans by caring for every person like family. That’s why we’re gathering smart, diverse, and big-hearted people to create a new kind of all-in-one healthcare company — one that combines compassion, health insurance, clinical care, service, and technology - to deliver a complete and integrated healthcare solution that delivers high quality care that everyone would want for someone they love. Founded in 2017, we've grown fast and now serve members across the United States. And we've just started. So join us on this mission!

  Job Description

  A bit about this role:
  

  As a Pharmacy Technician on the Formulary Management Team, you will perform oversight of various Part D formularies and contribute to drug specific evaluations and coverage recommendations by analyzing utilization patterns, monitoring new drug releases, and conducting comprehensive regulatory research to ensure CMS compliance. You will serve as a key contributor to ensure the overall success of our formulary management division to ensure that our members are well informed of all things related to pharmacy and formulary benefits.

  Embracing technology and innovation, our dynamic team navigates Medicare rules and regulations while prioritizing exceptional member care. We’re looking for a certified pharmacy technician experienced in managed care specifically Part D/MAPD and who has had additional PBM collaboration relative to the administration of Part D and Part B pharmacy claims. Additionally, having a strong overall drug knowledge coupled with analytical skills that can help proficiently navigate data and BI tools will be highly valued in candidates.

  At Devoted Health, we're dedicated to providing personalized, coordinated care to every Medicare-eligible member, aligning with the care and support we'd want for our own families.

  Responsibilities will include:
  

  • Contribute to the development, implementation, maintenance, and evaluation of formularies, ensuring adherence to CMS rules and state-specific regulations.

  • Collaborate across departments to analyze data influencing pharmacy benefits, tier placements, VBID participation, and excluded drug coverage decisions.

  • Conduct detailed analysis of various data points alongside clinical pharmacists to assess drugs for formulary placement.

  • Coordinate the review of formulary and utilization management recommendations with finance and other relevant departments as needed.

  • Assist in preparing timely formulary submission files and CMS submissions via HPMS.

  • Oversee change notification processes and drug file maintenance to uphold accuracy and operational efficiency.

  • Provide clinical expertise and support to internal teams and members, acting as a go-to resource for formulary-related inquiries.

  • Effectively communicate formulary changes and updates to internal and external stakeholders.

  • Support the creation of the user interface and offer expertise for the online formulary search tool.

  • Perform quality assurance checks on formulary submissions, bid submissions, formulary documents, and other documents as assigned.

  • Manage and maintain accuracy in published formulary documents on the website.

  • Create, implement, and maintain policies and procedures for effective formulary management.

  • Perform regulatory plan document reviews as a pharmacy benefit Subject Matter Expert (SME) for EOC, Summary of Benefits, ANOCs, LIS Riders, etc.

  • Manage the clinical pharmacy inbox, responding to any inquiries from external partners and triaging emails to business owners.

  • Review overrides entered by the pharmacy team for accuracy and ensure they follow the internal override policy.

  • Develop and maintain internal knowledge resources.

  • Assist in various ad-hoc projects and responsibilities as needed to support the functioning of the department or organization.
    

  Attributes to success:

  • You thrive in a fast-paced, dynamic environment and are a self-starter.

  • You feel accountable for the work you’re responsible for.

  • You’re a problem solver by nature - schedules will change, things will come up, the printer will break, people will ask you for help.

  • You are a transparent communicator about your work, what’s going well, and what's not; and thoughtful about adapting and finding new and innovative ways for improving processes

  • You have a big heart: you love operations, but you also see that caring for members like family means loving and serving each individual.

  • Agility and collaboration are critical to your success - you may be asked to do several things and need to change plans mid day.

  • You’re highly organized and meticulous when it comes to the details.

  • You’re naturally curious. You have the ability to recognize process deficiencies, recommend improvements and implement solutions.

  • You have a bias towards action and execution, and a track record to support your ability to get things done.
    

  Desired skills and experience:

  • Nationally Certified Pharmacy Technician (CPhT) in good standing

  • 2+ years of experience with Medicare Part D operations (e.g. pharmacy help desk, utilization management, formulary management) at a Health Plan and/or PBM, Strongly Preferred

  • Strong analytical skills - you are confident making sense of operations through data, you can establish quantitative goals, and you can articulate a case from first principles

  • Familiar with drug products, both generic and brand name drugs

  • Experience utilizing business intelligence tools to interpret, analyze, and visualize data with a high degree of technological aptitude, Preferred

  #LI-SH1
  
  Salary Range: $19.00 - $27.00 / hour

  Healthcare equality is at the center of Devoted’s mission to treat our members like family. We are committed to a diverse and vibrant workforce. If you lack a specific credential for this position but believe that your strengths and life experiences will propel our mission, we would love to hear from you.

  Our Total Rewards package includes:

  • Employer sponsored health, dental and vision plan with low or no premium

  • Generous paid time off

  • $100 monthly mobile or internet stipend

  • Stock options for all employees

  • Bonus eligibility for all roles excluding Director and above; Commission eligibility for Sales roles

  • Parental leave program

  • 401K program

  • And more....

  *Our total rewards package is for full time employees only. Intern and Contract positions are not eligible.

  The salary and/or hourly range listed is a good faith determination of potential base compensation that may be offered to a successful applicant for this position at the time of this job advertisement and may be modified in the future. When determining a team member's base salary and/or rate, several factors may be considered as applicable (e.g., location, specialty, years of relevant experience, education, credentials, budget and internal equity).

  Devoted is an equal opportunity employer. We are committed to a safe and supportive work environment in which all employees have the opportunity to participate and contribute to the success of the business. We value diversity and collaboration. Individuals are respected for their skills, experience, and unique perspectives. This commitment is embodied in Devoted’s Code of Conduct, our company values and the way we do business.

  As an Equal Opportunity Employer, the Company does not discriminate on the basis of race, color, religion, sex, pregnancy status, marital status, national origin, disability, age, sexual orientation, veteran status, genetic information, gender identity, gender expression, or any other factor prohibited by law. Our management team is dedicated to this policy with respect to recruitment, hiring, placement, promotion, transfer, training, compensation, benefits, employee activities and general treatment during employment.

• About the company

  We want to make your healthcare easier, more affordable, and a whole lot more caring. And we've got the Medicare Advantage plans to make it happen.

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