Clinical Formulary Pharmacist

Founded in 1977 as the Senior Care Action Network, SCAN began with a simple but radical idea: that older adults deserve to stay healthy and independent. That belief was championed by a group of community activists we still honor today as the "12 Angry Seniors." Their mission continues to guide everything we do.

Today, SCAN is a nonprofit health organization serving more than 500,000 people across Arizona, California, Nevada, New Mexico, Texas, and Washington, with over $8 billion in annual revenue. With nearly five decades of experience, we have built a distinctive, values-driven platform dedicated to improving care for older adults.

Our work spans Medicare Advantage, fully integrated care models, primary care, care for the most medically and socially complex populations, and next-generation care delivery models. Across all of this, we are united by a shared commitment: combining compassion with discipline, innovation with stewardship, and growth with integrity.

At SCAN, we believe scale should strengthen-not dilute-our mission. We are building the future of care for older adults, grounded in purpose, accountability, and respect for the people and communities we serve.

The Job

This position will play an important role in providing operational support for evaluation, implementation, and maintenance of Medicare Part D Formulary and Utilization Management, review of new drugs with the Pharmacy & Therapeutics Subcommittee/Committee. This position is accountable for ensuring regulatory compliance with respect to the Medicare Part D formulary submissions to CMS, pharmacy benefits, formulary and transition program implementation with PBM, website content for all business lines, pharmacy network and CMS's Part D regulatory audits. The Clinical Pharmacist stays abreast of pharmacy, PBM, payer industry changes, pipeline, drug trends, best practices, and CMS's rules and regulations, including Inflation Reduction Act. The role requires strong cross functional collaboration and communication skills, and an understanding of Medicate Part D formulary and Utilization Management (UM) processes.

You Will

Ensures regulatory compliance with P&T operations, Formulary & Benefit Administration, TransitionPrograms, annual Part D bid submission process, pharmacy-related member and otherstakeholders' communications and marketing materials, including member formulary drug list,website content, trainings, pharmacy network and CMS's regulatory audits.

Produces, maintains, and implements Part D Formulary, Prior Authorization criteria, Step Therapycriteria, Supplemental files, and clinical rules in accordance with CMS requirements on monthly andannual basis and submits these files to CMS. Develops and maintains formulary exception criteria.

Evaluates and reviews new drugs/biosimilar with the Pharmacy & TherapeuticsSubcommittee/Committee within 90-180 days of being marketed and makes Formulary and UMrecommendations based on the clinical appropriateness, cost analysis and CMS guidelines. Worksin collaboration with Medical Directors to evaluate and analyze treatment protocols and proceduresrelated to the SCAN Health Plan formulary, at least annually.

Provides CMS Part D regulatory audit support for respective areas. Produces membercommunications and marketing materials, within internally determined timeframes, with accuracyand in accordance with CMS marketing guidelines. Partners with Marketing, Compliance andMember Services and vendors, as needed. Prepares training materials.

Maintains on-line comprehensive formulary on a monthly basis on accordance with CMSrequirements. Assists with Formulary and UM modeling for the annual Formulary and BIDsubmissions to CMS. Reviews accuracy of the Formulary, UM files, and Pharmacy Benefits for theannual BID submission to CMS.

Prepares Formulary/Pharmacy Benefits Industry Analysis annually. Complies and implementsInflation Reduction Act requirements with PBM and CMS Innovation Programs, as needed.

Monitors drug pipeline, drug trends, and payer industry changes throughout the year to identifypotentially high Part D impact drugs. Manages Part B drug trend and value-based opportunities.Oversees PBM operations in the areas of Formulary, Opioid Safety Edits, Pharmacy Benefits,Transition Programs, Prescriber Enrollment Requirements and Pharmacy Network Implementation.

Ensures AEP and 1/1 readiness and assists in training of other departments. Serves as the clinicalsubject matter expert for respective areas, providing guidance as needed.

Maintains current knowledge of Medicare Part D regulations by participating in CMS calls andreading released guidance and implementing changes to maintain compliance. Manages multipledeadlines and completes projects with 100% accuracy.

Maintains professional and technical knowledge by conducting research and by attendingeducational and technological workshops. This position requires contributions to team efforts byaccomplishing and sharing related results with other staff. Collaborates with other team memberswithin the Pharmacy Department; collaborates with other SCAN departments: Compliance,
Marketing, HCI, Product, Member Services to support the achievement of SCAN's Vision andGoals.

We seek Rebels who are curious about AI and its power to transform how we operate and serve our members.

Actively support the achievement of SCAN's Vision and Goals.

Other duties as assigned.

Your Qualifications

Bachelor's Degree required - Pharm D

Required Certifications or Licenses: Pharmacists (PHs)

Experience Required: Registered Pharmacy Licensure required within 6 months of hire

Residency Program in Managed Care, Pharmacy Practice, Drug Information or Geriatric Pharmacy, preferred.

Managed care experience at the PBM, health plan or medical group, required.

Medicare Part D experience in formulary management, required.

3-5 years of related experience.

Technical expertise - Strong analytical skills

Problem Solving - Basic problem-solving skills

Communication - Good communication and interpersonal skills

Tableau, and/or Alteryx preferred

Excellent verbal/written communication, interpersonal, presentation, customer, problem-solving andcomputer skills, required.

Effective utilization of information systems required.

What's in it for you?

• Base salary range: $125,400 to $$181, 419 per year

• Mostly remote work mode

• An annual employee bonus program

• Robust Wellness Program

• Generous paid-time-off (PTO)

• Eleven paid holidays per year, plus 1 additional floating holiday, plus 1 birthday holiday

• Excellent 401(k) Retirement Saving Plan with employer match

• Robust employee recognition program

• Tuition reimbursement

• An opportunity to become part of a team that makes a difference to our members and our community every day!

We're always looking for talented people to join our team! Qualified applicants are encouraged to apply now!

At SCAN we believe that it is our business to improve the state of our world. Each of us has a responsibility to drive Equality in our communities and workplaces. We are committed to creating a workforce that reflects our community through inclusive programs and initiatives such as equal pay, employee resource groups, inclusive benefits, and more.

SCAN is proud to be an Equal Employment Opportunity and Affirmative Action workplace. Individuals seeking employee will receive consideration for employment without regard to race, color, national origin, religion, age, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender perception or identity, age, marital status, disability, protected veteran status or any other status protected by law. A background check is required.

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Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities

The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor's legal duty to furnish information. 41 CFR 60-1.35(c)