Manager, Formulary & Medical Pharmacy Operations at Oscar Health

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Full Time

Start Date

Immediate

Expiry Date

30 Apr, 26

Salary

189000.0

Posted On

30 Jan, 26

Experience

5 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Formulary Management, Medical Pharmacy Operations, Clinical Pharmacy Initiatives, Affordability Savings, Medical Economics Partnership, Clinical Affairs Operationalization, Trend Management, Clinical Effectiveness, Affordability Process Contribution, Affordability Projects Management, Utilization Management, P&T Committee Management, Cost Reduction Programs, Regulatory Inquiries Response, Mental Health Parity Compliance, Change Management

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: If you are located in New York, NY or Tempe, AZ, this role is 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. For all the following locations: This is a remote position, open to candidates who reside in: Alabama; Arizona; Arkansas; Colorado; Connecticut; District of Columbia; Florida; Georgia; Idaho; Illinois; Indiana; Iowa; Kansas; Kentucky; Maine; Maryland; Massachusetts; Michigan; Minnesota; Missouri; Nevada; New Hampshire; New Jersey; New Mexico; North Carolina; Ohio; Oregon; Pennsylvania; Rhode Island; South Carolina; Tennessee; Texas; Utah; Vermont; or Virginia. While your daily work will be completed from your home office, occasional travel may be required for team meetings and company events. #LI-Remote 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 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 Privacy Policy.

Responsibilities

This role oversees and manages clinical pharmacy initiatives focused on driving affordability savings, including core formulary management operations and monitoring savings initiatives across pharmacy and medical benefits. Responsibilities also include operationalizing, developing, and maintaining a clinically appropriate and cost-effective formulary by managing the P&T committee.