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, Senior 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 also lead in the creation of custom solutions to maintain compliance with state and federal mandates by interpreting mandates, gathering requirements from business owners, developing implementation plans, documenting system processes, and coordinating with cross functional business partners. You will act as subject matter expert to ensure formulary decisions and drug lists 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 Knowledge and Experience

• Requires a college degree or equivalent experience
• Requires 5 years of prior relevant experience
• Experience working with Pharmacy Benefit Management systems or vendors
• Knowledge of Pharmacy Benefit design and Formulary configuration; knowledge of Blue Shield of California (or similar health care organization) pharmacy configuration is preferred
• Knowledge of regulatory requirements (Commercial and/or Medicare) related to formularies and utilization management
• Strong coordination and interpersonal skills working in a matrixed environment with multiple stakeholders
• Familiarity with Medispan drug files is preferred
• Knowledge of project management
• 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
• Knowledge of California's pharmacy benefit compliance requirements is preferred