Formulary Operations Specialist

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 .

Position Responsibilities:  

Supports the weekly, monthly, and quarterly maintenance and quality assurance checks of standard and custom formularies for all lines of business including Commercial, Medicaid, Medicare Part D, and the Health Information Marketplace  

Assists the pharmacists in operationalizing nd implementing custom client formulary and benefit requests within the formulary management and adjudication platform  

Triages and assists with Salesforce cases for custom formularies  

Triages and monitors the Formulary Operations inbox  

Uploads formulary composites in the adjudication platform and supports Benefits team testing by uploading adjudication data to applicable Salesforce cases  

Assists the pharmacists with cross functional support for claim troubleshooting through the adjudication platform  

Reviews formulary testing output templates for formulary accuracy  

Supports the creation, maintenance, and validation of client and formulary marketing materials in the formulary management tool  

Conducts adjudication system maintenance data entry activities  

Inputs inactive to active NDC updates  

Supplemental list updates in Medispan for pharmacists to perform quality checks  

Creates non-formulary tier flips in the formulary management tool   

Performs weekly formulary updates for Liberty, Freedom, and standard HIM formularies  

Weekly moratorium updates, and weekly utilization management updates in the formulary management tool  

Performs Monthly Specialty formulary updates in the formulary management tool  

Provides support to Weekly New Drug to Market updates  

Assists with creating job aids for Formulary Operations  

Develops and maintains departmental SharePoint sites  

Completes assigned work plan objectives and projects on a timely basis  

Ensures quality assurance and formulary accuracy  

Support quality improvement projects, as required  

Support RFI and RFP submissions, as required  

Support general business needs and operations, as required  

Responsible for adherence to the Judi Rx Code of Conduct, including reporting of noncompliance  

Performs other duties and responsibilities as needed  

Required Qualifications:  

Registered Pharmacy Technician license   

Certification from the National Pharmacy Technician Certification Board or National Health career Association or   equivalent experience  

3-4 years of pharmacy experience working for a health plan or PBM   

Formulary development and maintenance process experience at a PBM or health plan including experience with custom client benefit and formulary design highly preferred  

Proficient in Microsoft office suite with emphasis on Microsoft Excel including advanced Microsoft Excel functions, VBA, macros, etc.  

Experience working with large datasets required  

Knowledge of pharmacy claims processing drug names, and pharmacy/medical terminology  

High attention to detail required   

Ability to work independently and accurately in a fast-paced environment  

Flexible, highly organized, and able to shift priorities easily  

Ability to balance multiple projects simultaneously  

Commitment to delivering a high-quality work product  

New York, NY Salary Range $70,000 — $85,000 USD

All employees are responsible for adherence to the Judi Health Code of Conduct including the reporting of non-compliance. This position description is designed to be flexible, allowing management the opportunity to assign or reassign duties and responsibilities as needed to best meet organizational goals.

We provide equal employment opportunities to all employees and applicants for employment and prohibit discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, medical condition, genetic information, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.  

By submitting an application, you agree to the retention of your personal data for consideration for a future position at Judi Health. More details about Judi Health's privacy practices can be found at   https://www.judi.health/legal/privacy-policy .