Formulary Operations Pharmacist
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 PBM for self-insured employers), Judi Health™ (full-service health benefit management), and Judi® (the industry’s leading Enterprise Health Platform). Together with our clients, we’re rebuilding trust in U.S. healthcare.
About the role
The Formulary Operations Pharmacist – Medicare provides operational support for the evaluation, implementation, and maintenance of Medicare Part D formularies and utilization management. This role supports formulary and utilization-management lists, CMS formulary-file preparation, member drug-list updates, and other formulary-related tasks. It requires cross-functional collaboration, Medicare Part D expertise, and adherence to CMS rules and regulations. The position also supports non-Medicare formulary tasks as opportunities arise.
Responsibilities
- Maintain standard and custom Medicare formularies in accordance with CMS guidelines
- Develop, implement, maintain, and quality-control Medicare Part D formularies, utilization management, and clinical adjudication drug lists
- Prepare monthly and annual CMS formulary submissions, member formulary drug lists, look-up tools, and utilization-management criteria
- Expand responsibilities across non-Medicare business lines to drive alignment, operational excellence, and strategic execution
- Evaluate drugs and drug classes to recommend formulary positioning, utilization-management strategies, and adjudication requirements
- Operationalize custom client formulary and benefit-change requests within the adjudication platform
- Create customized marketing materials (member formulary drug lists, utilization-management documentation, web-based look-up tools)
- Support comprehensive testing of client formulary and benefit elections
- Support custom formulary client trade and rebate strategy evaluation
- Identify automation opportunities and collaborate with Analytics to streamline processes
- Analyze pharmacy cost-of-care and clinical updates to develop formulary-management programs and utilization-management edits
- Provide clinical support to operational teams and clients during implementations
- Serve as clinical-operations liaison for ad-hoc sales requests and strategic client communications
- Perform quality-assurance checks of Formulary Specialist activities, emphasizing adjudication accuracy
- Provide cross-functional support for claims troubleshooting within the adjudication platform
- Monitor and analyze regulatory and legislative requirements for Medicare
- Lead and support timely submission of required reporting to State and Federal regulators (e.g., HPMS formulary submissions)
- Support development of project plans to meet new CMS requirements and cross-functional implementation
- Lead formulary-change processes within URAC/NCQA/CMS guidelines
- Support Pharmacy and Therapeutics (P&T) committee items as required
- Maintain and update the Rx pharmaceutical pipeline, develop monthly newsletters, and other client communications
- Develop clinical criteria for review as needed
- Support CMS Program Audits as a formulary-administration subject-matter expert
- Support Quality Improvement projects, clinical value projects, and continuous improvement initiatives
- Support Request for Information (RFI) and Request for Proposal (RFP) submissions
- Support general business needs and operations
- Review new regulatory guidance impacting formulary administration and provide compliant-action guidance
- Maintain compliance with all regulatory and organizational deadlines
- Adhere to the Judi Rx Code of Conduct, including reporting noncompliance
- Perform other duties and responsibilities as needed
Requirements
- Doctor of Pharmacy (PharmD) Degree from an accredited institution
- Current, unrestricted registered pharmacist license(s)
- Residency/fellowship preferred
- 2+ years of Medicare formulary experience working for a health plan or PBM
- Knowledge of formulary development and maintenance processes
- Knowledge of highly managed specialty medications and rebate/financial implications of formulary strategies
- Experience working with large datasets
- Ability to independently identify, research, and resolve issues
- Ability to balance multiple complex projects simultaneously
- Ability to work extended hours, weekends, and holidays consistent with industry demands
- Exceptional written and verbal communication skills
- Extremely flexible, highly organized, and able to shift priorities easily
- Attention to detail and commitment to delivering high-quality work
- Proficient in Microsoft Office suite with strong emphasis in Microsoft Excel
Pay
Salary ranges (base):
- Remote (U.S.): $125,000 – $135,000 USD
- New York, NY: $125,000 – $135,000 USD
- Denver, CO: $125,000 – $135,000 USD
- Charlotte, NC: $125,000 – $135,000 USD
Actual base salary will depend on experience, knowledge, skills, and location.
Schedule
Hybrid (local to New York, New York; Denver, Colorado; or Charlotte, North Carolina area).