Your Role

The Formulary Management team leads the development and maintenance of multiple formularies to support competitive health plan products, manage cost-of-healthcare, and meet regulatory requirements for all lines of business including Commercial Large Group, Commercial Small Group, Individual/Family plan, and Medicare. The Business Analyst, Experienced position will report to the Senior Manager of Formulary Management. In this role you will help determine requirements necessary for the build, implementation, and maintenance of formularies, including utilization management strategies. You will gather requirements from business owners, develop implementation plans, document system processes, and coordinate with cross functional business partners. You will act as subject matter expert to ensure formulary decisions are implemented in accordance with business rules and regulatory requirements, and you may be asked to support audits or lead projects with minimal supervision and guidance.

Your Work

In this role, you will:

• Provide complex analytical support through the analysis and interpretation of data in support of cross-functional business operations
• Develops annual operating plans, capital budgets and forecasts, and build business cases for new business initiatives (cost/benefit analysis)
• Develop, prepare and analyze reports for management review, and present to various levels of management
• Define business requirements and provide analysis to increase operational efficiency
• Analyze actual results against plan and forecast and recommend interventions where appropriate
• Identifies opportunities for improvements in operation performance and notifies management of issues and problems requirements immediate attention.
• Develop, review, and update written system processes and operational workflows related to formulary management
• Develop and implement work plan for formulary enhancements that support cost-of-healthcare initiatives
• Act as subject matter expert for formulary processes in support of state and federal audits
• Occasional business travel required
• Other duties as assigned

Your Knowledge and Experience

• Requires a bachelor's degree or equivalent experience
• Requires at least 5 years of prior relevant experience working with Pharmacy Benefit Management systems or vendors
• Requires knowledge of Pharmacy Benefit design and Formulary configuration; knowledge of Blue Shield of California (or similar health care organization) pharmacy configuration preferred
• Knowledge of regulatory requirements (Commercial and/or Medicare) related to formularies and utilization management
• Requires strong coordination and interpersonal skills working in a matrixed environment with multiple stakeholders
• Familiarity with Medispan drug files is preferred
• Requires demonstrated experience documenting processes, identifying process gaps, managing multiple projects, and implementing industry best practices
• Knowledge of Commercial and Medicare Part D formulary requirements is preferred

Pay Range:

The pay range for this role is: $75,700.00 to $113,500.00 for California.

Note:

Please note that this range represents the pay range for this and many other positions at Blue Shield that fall into this pay grade. Blue Shield salaries are based on a variety of factors, including the candidate's experience, location (California, Bay area, or outside California), and current employee salaries for similar roles.