Job Opportunities API

About Judi Health Judi Health is an enterprise health technology company providing a comprehensive suite of solutions for employers and health plans, including: Judi Rx , a public benefit corporation delivering full-service pharmacy benefit management (PBM) solutions to self-insured employers, Judi Health™ , which offers full-service health benefit management solutions to employers, TPAs, and health plans, and Judi® , the industry’s leading proprietary Enterprise Health Platform (EHP), which consolidates all claim administration-related workflows in one scalable, secure platform. Together with our clients, we’re rebuilding trust in healthcare in the U.S. and deploying the infrastructure we need for the care we deserve. To learn more, visit www.judi.health . Location: Hybrid (Local to New York, New York; Denver, Colorado; or Charlotte, North Carolina area)   Position Summary:   The Formulary Operations Pharmacist – Medicare is responsible for providing operational support for the evaluation, implementation, and maintenance of Medicare Part D formularies and utilization management. This individual supports creation and maintenance of formulary and utilization management lists, preparation of CMS formulary files and member formulary drug lists, preparation and review of updates for implementation, and other formulary and utilization management related tasks and processes. The role requires strong cross functional collaboration and communication skills, and an understanding of Medicare Part D formulary management processes and related CMS rules and regulations.  The position also  provide s   support   to  non-Medicare formulary  management  tasks as opportunities arise.   Position Responsibilities:   Maintain standard and custom formularies for the Medicare line of business in accordance with CMS Medicare guidelines   Supports the development, implementation, maintenance, and quality control of Medicare Part D formularies, utilization management, and clinical adjudication drug lists   Leads and supports the preparation of monthly and annual files for CMS formulary submissions, member formulary drug lists and look up tools, and utilization management criteria   Expanded scope of responsibilities across other non-Medicare business lines when needed, driving alignment, operational excellence, and strategic execution across diverse functions   Evaluate drugs and drug classes,  to provide formulary positioning and utilization management recommendations, and update formulary management strategies and associated adjudication requirements to operationalize   Evaluates the appropriateness of and operationalizes custom client formulary and benefit change requests within the formulary and adjudication platform   Creates customized marketing materials, including but not limited to member formulary drug lists, utilization management criteria documentation, and web-based look up tools   Supports the comprehensive testing of client formulary and benefit elections   Supports custom formulary client trade and rebate strategy evaluation   Identifies opportunities for automation and collaborates with Analytics to streamline processes and workflows   Analyzes pharmacy cost of care and clinical updates for the development of formulary management programs and utilization management edits   Provides clinical support to operational teams and clients during implementations   Serves as the clinical operations liaison to assist with ad-hoc sales requests and strategic communications for clients to provide expert insights from a clinical perspective   Quality assur