Manager, Formulary & Medical Pharmacy Operations at Oscar Health

New York, New York, United States -

Full Time

Start Date

Immediate

Expiry Date

26 Jan, 26

Salary

189000.0

Posted On

28 Oct, 25

Experience

5 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Clinical Pharmacy, Formulary Management, Project Management, Change Management, Medication Adherence, Chronic Disease Management, Patient Education, Cost Reduction, Regulatory Compliance, Cross-Functional Collaboration, Data Analysis, Pharmacy Operations, Drug Treatment Evaluation, Performance Monitoring, Mental Health Parity

Industry

Insurance

Description

Hi, we're Oscar. We're hiring a Manager, Formulary & Medical Pharmacy Operations to join our Pharmacy team. Oscar is the first health insurance company built around a full stack technology platform and a focus on serving our members. We started Oscar in 2012 to create the kind of health insurance company we would want for ourselves—one that behaves like a doctor in the family. About the role You will oversee and manage clinical pharmacy initiatives driving affordability savings including core formulary management operations. You will partner across Pharmacy, Medical Economics, and the Office of Clinical Affairs to operationalize pharmacy related workflows and monitor existing savings initiatives for drugs on both the pharmacy and medical benefits. You will report to the Senior Manager, Formulary Operations and Pharmacy Utilization Management. Work Location: This position is based in our New York, NY office, requiring a hybrid work schedule with 3 days of in-office work per week. Thursdays are a required in-office day for team meetings and events, while your other two office days are flexible to suit your schedule. #LI-Hybrid Pay Transparency: The base pay for this role is: $144,000 - $189,000 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program and annual performance bonuses. Responsibilities Provide insights and recommendations for trend management and clinical effectiveness, including serving as a key contributor in the enterprise affordability process for pharmacy Manage the pipeline of enterprise affordability projects across the pharmacy department (program operations and clinical) and oversee the performance of active initiatives Partner with leads across the organization as necessary in order to communicate, understand and identify upstream and downstream impacts to the business Contribute to the design and implementation of clinical programs focused on improving patient outcomes and reducing costs. These programs may include medication adherence initiatives, chronic disease management programs, and patient education efforts Operationalize, develop and maintain a clinically appropriate and cost-effective formulary by operating and managing Oscar's P&T committee, which includes evaluating new developments in the drug treatment landscape and providing recommendations on how to manage new to market drugs and new drug indications. Oversee and optimize medical pharmacy preferred drug lists and strategies to supports utilization of lowest unit cost infusion products Provide written recommendations with responses and corresponding documentation for regulatory inquiries, feedback on future legislation, and other business questions that probe at formulary operations. Accountable and responsible for maintaining mental health parity NQTL responses and working cross-functionally for future filings and responding to ongoing objections during the audit process. Compliance with all applicable laws and regulations Other duties as assigned Qualifications Doctor of Pharmacy degree (PharmD) 4+ years working for PBM or Payer in clinical pharmacy operations 4+ years leading cross-functional teams/projects and change management 3+ years supporting formulary management (P&T Committee, clinical policy development, formulary run operations) Bonus points Residency Training Experience with Marketplace Exchange and Medicare Advantage This is an authentic Oscar Health job opportunity. Learn more about how you can safeguard yourself from recruitment fraud here. At Oscar, being an Equal Opportunity Employer means more than upholding discrimination-free hiring practices. It means that we cultivate an environment where people can be their most authentic selves and find both belonging and support. We're on a mission to change health care -- an experience made whole by our unique backgrounds and perspectives. Pay Transparency: Final offer amounts, within the base pay set forth above, are determined by factors including your relevant skills, education, and experience. Full-time employees are eligible for benefits including: medical, dental, and vision benefits, 11 paid holidays, paid sick time, paid parental leave, 401(k) plan participation, life and disability insurance, and paid wellness time and reimbursements. Artificial Intelligence (AI): Our AI Guidelines outline the acceptable use of artificial intelligence for candidates and detail how we use AI to support our recruiting efforts. Reasonable Accommodation: Oscar applicants are considered solely based on their qualifications, without regard to applicant’s disability or need for accommodation. Any Oscar applicant who requires reasonable accommodations during the application process should contact the Oscar Benefits Team (accommodations@hioscar.com) to make the need for an accommodation known. California Residents: For information about our collection, use, and disclosure of applicants’ personal information as well as applicants’ rights over their personal information, please see our Notice to Job Applicants.

Responsibilities

Oversee and manage clinical pharmacy initiatives to drive affordability savings and manage formulary operations. Partner with various departments to operationalize pharmacy workflows and monitor savings initiatives for drugs on pharmacy and medical benefits.