About this opportunity
Capital Rx lists this Formulary Operations Pharmacist opportunity in denver, Colorado. Review the employer’s description below for duties, qualifications and application requirements.
Job description
About Judi Health
Judi Health is a health technology company providing benefit administration solutions to employers, unions, health plans, and government entities. Judi Health replaces fragmented, outdated systems with the industry's first Unified Claims Processing architecture, seamlessly consolidating pharmacy and medical benefit administration on a single, secure platform. By delivering true price transparency, eliminating unnecessary middleman fees, and leveraging advanced AI-powered care delivery, Judi Health helps clients achieve unprecedented operational efficiency and service levels.
At Judi Health, we're deploying the infrastructure our country needs to deliver the healthcare we all deserve. We are the intelligence platform powering benefits plans for millions of Americans and proudly leading the next generation of care. To learn more, visit
Location: Hybrid (Local to NewYork, New York; Denver, Colorado; or Charlotte, North Carolinaarea)
Position Summary:
The Formulary Operations Pharmacist - Medicare is responsible for providing operational support for the evaluation, implementation, and maintenance of Medicare Part D formularies and utilization management. This individual supports creation and maintenance of formulary and utilization management lists, preparation of CMS formulary files and member formulary drug lists, preparation and review of updates for implementation, and other formulary and utilization management related tasks and processes. The role requires strong cross functional collaboration and communication skills, and an understanding of Medicare Part D formulary management processes and related CMS rules and regulations.The position alsoprovides supporttonon-Medicare formularymanagementtasks as opportunities arise.
Position Responsibilities:
Maintain standard and custom formularies for the Medicare line of business in accordance with CMS Medicare guidelines
Supports thedevelopment, implementation, maintenance, and quality control of Medicare Part D formularies, utilization management, and clinical adjudication drug lists
Leadsand supports thepreparation of monthly and annual files for CMS formulary submissions, member formulary drug lists and look up tools, andutilization management criteria
Expanded scope ofresponsibilities across other non-Medicare business lines when needed, driving alignment, operational excellence, and strategic execution across diverse functions
Evaluate drugsanddrugclasses,toprovideformulary positioning and utilization management recommendations, and update formulary management strategies and associated adjudication requirements to operationalize
Evaluates theappropriateness of and operationalizescustom client formulary and benefit change requests within the formulary and adjudication platform
Creates customized marketing materials, including but not limited to member formulary drug lists, utilization management criteria documentation, and web-based look up tools
Supports thecomprehensive testing of client formulary and benefit elections
Supportscustom formulary client trade and rebate strategy evaluation
Identifies opportunities for automation and collaborates with Analytics to streamline processes and workflows
Analyzes pharmacy cost of care and clinical updates for the development of formulary management programs and utilization management edits
Provides clinical support to operational teams and clients during implementations
Servesas the clinical operations liaison to assist with ad-hoc sales requests and strategic communications for clients to provide expert insights from a clinical perspective
Quality assurance checks of Formulary Specialist activities, with emphasis on actions impacting adjudication of claims for accuracy
Providescross functional support for claimstroubleshooting within the adjudication platform
Monitorsand analyzesregulatory and legislative requirements for Medicare
Leads and supports timely submission of all required reporting to State and Federal regulators, such as required formulary submissions to Health Plan Management System (HPMS)
Supports thedevelopment of project plans to meet new CMS requirements, and supportscross functional teams with implementation of programs to meet requirements
Leadsformulary change processes within URAC/NCQA/CMS guidelines
SupportsPharmacy and Therapeutics (P&T) committee items, as required
Maintainsand updatesthe Rx pharmaceutical pipeline,development of monthly newsletters, and other client communicationsas needed
Developsclinical criteria for review as needed
SupportsCMSProgram Audits as a formulary administration subject matter expert and provide necessary input of information to complete any auditor requested deliverables, including but not limited to root cause analysis, beneficiary impact analysis, and corrective action plans
SupportsQualityImprovement projects, clinical value projects,and continuous improvement initiatives,as needed
SupportsRequest for Information (RFI) and Request for Proposal (RFP) submissions, as needed
Support general business needs and operations, as needed
Supportsreview of new regulatory guidance and regulations that impact formulary administration and provide guidance to internal and external stakeholders for compliant action
Maintainscompliance with all regulatory and organizational deadlines
Responsible for adherence to theJudiRx Code of Conduct including reporting of noncompliance
Performs other duties and responsibilities as needed
MinimumQualifications:
Doctor of Pharmacy (PharmD) Degree from an accredited institution
Current, unrestricted registered pharmacist license(s)
Residency/fellowship preferred
2+years ofMedicareformulary experience working for a health plan or PBM
Knowledge of formulary development and maintenance processes
Knowledge of highly managed specialty medications/strategy
Knowledge of rebate and financial implications of formulary strategies
Experience working with largedatasetsrequired
Ability to independently identify, research, and resolve issues
Ability to balance multiple complex projects simultaneously
Ability to work extended hours, weekends, and holidays consistent with industry demands
Exceptional written and verbal communication skills
Extremely flexible, highly organized, and able to shift priorities easily
Attention to detail & commitment to delivering high quality work product
ProficientinMicrosoft office suite withstongemphasisinMicrosoftExcel required
#LI-LC1
This range represents the low and high end of the anticipated base salary range. The actual base salary will depend on several factors such as: experience, knowledge, skills, and location of the job.
Remote, US Salary Range
$125,000—$140,000 USD
New York, NY Salary Range
$125,000—$140,000 USD
Denver, CO Salary Range
$125,000—$140,000 USD
Charlotte, NC Salary Range
$125,000—$140,000 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
Who can apply
Review the original listing for work authorization, qualifications and employer requirements.