The Pharmacy Benefits Management (PBM) PA Formulary Manager position is of high visibility and represents Legacy Veterans Integrated Service Network (VISN) 21's wide efforts to improve medical care. He/she will exercise initiative and collaborate effectively with clinical and administrative staff at the Legacy VISN 21 and VA facility level to promote and support quality patient care.
Some of the duties include but are not limited to: Using knowledge of VA formulary and clinical guidelines: reviews, adjudicates and provides education to prescribers to assist in optimizing clinical care to meet safety, clinical, quality or regulatory requirements. Consults with contracted care providers outside VA for contracted care to obtain information necessary to adjudicate prior authorization requests. Provides education to non-VA providers on VA formulary selection and informs supervisors of non-VA providers who continually are outlier prescribers. Integrates smaller scale educational concepts for time-sensitive campaigns to change prescribing patterns. These include, but are not limited to: PBM updates, polypharmacy containment, formulary process and controls, and approved drug conversions. Leads/Serves as an authoritative PBM representative on VISN Committees and workgroups. Critically reviews prior authorization drug requests from all VAMCs for appropriateness, utilizing clinical knowledge, National and VISN treatment guidelines, drug use criteria, and relevant literature and resources. Collaborates with PA Data Analyst, National and VISN PBMs to conduct prospective/retrospective drug use evaluations of high-risk, high-use or high-cost drugs. Serves as subject-matter-expert (SME) to VAMC providers and administration for questions regarding National criteria for use, treatment algorithms and VA National Formulary. Collects, monitors and utilizes feedback to monitor program outcomes, including cost-containment, healthcare resource utilization, satisfaction and clinical outcomes; provides feedback or successes for continued motivation and support for any necessary changes. Consistently responds to VISN PBM program inquiries, medication or other relevant requests in a timely, accurate, friendly, and professional manner across the spectrum of PBM internal and external customers. Work Schedule: Monday - Friday, 8:00am - 4:30pm PST (Subject to change to meet organizational needs) Telework: Ad-hoc per policy. Virtual: This is not a virtual position. Functional Statement #: 07979-F Relocation/Recruitment Incentives: Not authorized. Permanent Change of Station (PCS): Not authorized
Note: Only education or degrees recognized by the U.S. Department of Education from accredited colleges, universities, schools, or institutions may be used to qualify for Federal employment. You can verify your education here: http://ope.ed.gov/accreditation/. If you are using foreign education to meet qualification requirements, you must send a Certificate of Foreign Equivalency with your transcript in order to receive credit for that education. For further information, visit: https://sites.ed.gov/international/recognition-of-foreign-qualifications/.
michael.flournoy@va.gov 415-221-4810 X22865
Source: USAJOBS.gov — U.S. Federal Government
Apply on official site →