Aetna Pharmacy Service Manager (Aetna Medicaid) in Detroit, Michigan

Req ID: 49629BR

POSITION SUMMARY

The Formulary Management Clinical Advisor will report to the Senior Director, Formulary Management and Clinical Strategies. This role will be responsible for supporting the creation and maintenance of the Aetna Medicaid standard and/or state specific preferred drug list (PDL) and for providing oversight of the template Medicare formulary for the Medicare-Medicaid and Dual Eligible Special Need Plans assuring clinical appropriateness, accuracy, clinical consistency and compliance to state and CMS regulations.

This is a work at home position. The Aetna Medicaid Leadership Team is located in Phoenix, AZ with some travel required for annual meetings or plan meetings (10 -15%)

Fundamental Components:

Coordinate and support formulary activities to meet Aetna organization goals, meeting state regulatory mandated PDL requirements and CMS chapter 6 requirements for Medicare-Medicaid plans D-SNP plans.

Working knowledge of the Aetna Medicaid Formulary, variation of the Aetna Medicaid formulary to the specific assigned health plan formulary, and template Medicare formulary (if applicable).

Collaboration with assigned health plan Pharmacy Director on state mandated PDL requirements/CMS requirements to assure compliance with the contract.

Develop and maintain the formulary source of truth within the formulary management business application, including coordination of changes, quality assurance and checks of identified changes; and production of accurate PDL/Formulary documents for health plan website posting, including specific health plan information (front matter).

Monitoring and identifying of new drugs to market through the review of the Medispan file, coordination with PBM on new drug monographs, generic availability and/or new FDA indications.

Complete new drug reviews, both clinical and financial analysis, for recommendation to the clinical subcommittee for potential inclusion and/or removal for a drug to the Aetna Medicaid formulary, including appropriate utilization management edits.

Develop new drug presentation and present to the clinical subcommittee to support rational and clinical/financial analysis

Collaboration and coordination with Prior Authorization Operations for new PA Guidelines requirements and/or updates to existing PA Guidelines to support recommendations to the Aetna Formulary UM requirements.

Participate as a member of the clinical and P&T subcommittees to present formulary recommendations; track discussion and outcomes of decisions.

Support development of all quarterly National Pharmacy and Therapeutic Committee meetings as well as local P&T committee meetings, where applicable.

Completion of formulary change request and submission to the PBM; including support for validation of changes with the PBM Benefit Review Manager (BRM).

Complete pre and post validation testing of all submitted formulary/PDL changes.

Maintain the Shared email folder and mailbox for auditing purposes.

Serve as liaison between Aetna Medicaid and our PBM.

Provide oversight of the Medicare-Medicaid and D-SNP plans formulary activities in coordination with the respective Pharmacy Directors.

BACKGROUND/EXPERIENCE:

In-depth knowledge and experience in managed care / managed pharmacy / competitive environment.

3 years clinical pharmacy/administrative experience or equivalent.

EDUCATION

The highest level of education desired for candidates in this position is a Doctor of Pharmacy.

LICENSES AND CERTIFICATIONS

Pharmacy/Registered Pharmacist is required

ADDITIONAL JOB INFORMATION

Aetna is about more than just doing a job. This is our opportunity to re-shape healthcare for America and across the globe. We are developing solutions to improve the quality and affordability of healthcare. What we do will benefit generations to come.

We care about each other, our customers and our communities. We are inspired to make a difference, and we are committed to integrity and excellence.

Together we will empower people to live healthier lives.

Aetna is an equal opportunity & affirmative action employer. All qualified applicants will receive consideration for employment regardless of personal characteristics or status. We take affirmative action to recruit, select and develop women, people of color, veterans and individuals with disabilities.

We are a company built on excellence. We have a culture that values growth, achievement and diversity and a workplace where your voice can be heard.

Benefit eligibility may vary by position. Click here to review the benefits associated with this position.

Aetna takes our candidate's data privacy seriously. At no time will any Aetna recruiter or employee request any financial or personal information (Social Security Number, Credit card information for direct deposit, etc.) from you via e-mail. Any requests for information will be discussed prior and will be conducted through a secure website provided by the recruiter. Should you be asked for such information, please notify us immediately.

Job Function: Health Care