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Formulary Operations
Posted on 7/26/2022
United States
Experience Level
Desired Skills
  • Doctor of Pharmacy degree (PharmD)
  • 5+ years working for PBM or Payer in clinical pharmacy operations
  • 5+ years leading cross-functional teams/projects and change management
  • Ensure that the existing formulary meets clinical, regulatory, and financial performance standards: This role is accountable for: ensuring clinical quality standards are met by maintaining clinical policies used for decision-making; ensure that compliance standards set by regulators and NCQA are defined in policies, that procedures are documented, and that those processes audited
  • Operationalize and maintain an updated formulary: This role is accountable for: operating Oscar Management Corporation's (OMC) Pharmacy & Therapeutics Committee (P&T Committee), Monitoring new to market drugs (NTMs) and designating formulary/UM status within regulatory required timeframes, ensuring claims testing validates that formulary changes are effectuated correctly, sending internal/external notifications on formulary changes, updating member/provider facing materials, ensuring drug recall communications are sent, submitting regulatory filings for formulary submission, and ongoing monitoring and oversight to ensure formulary is driving cost-effective drug mix/utilization
  • Responding to formulary inquiries from internal partners and regulators: Responsible for providing written responses and corresponding documentation for regulatory inquiries, feedback on future legislation, and other business questions that probe at formulary operations
  • Mental Health Parity: Accountable and responsible for maintaining mental health parity NQTL responses and coordinating with our teams for future filings and ongoing objections during the audit process
Desired Qualifications
  • Residency Training
  • 3+ years supporting formulary management (P&T Committee, clinical policy development, formulary run operations)
  • Experience with Marketplace Exchange and Medicare Advantage
Oscar Health

1,001-5,000 employees

Health insurance company
Company mission
Oscar Health’s mission is to make high-quality health insurance accessible and affordable for everyone. The company is a software driven health insurance company that offers medical plans, medicare advantages, and small group products.
  • Health insurance - That’s a given. Employees and their families receive incredible health insurance.
  • Financial benefits - A penny saved....we’re talking about a 401K plan, health savings accounts, and more.
  • Well @ Oscar - We care about your wellness with fitness classes and access to mental health support.
  • Work-Life Balance - We offer multiple time-off options, wellness days, and 10+ weeks of parental leave.
  • Learning & Development - We offer everything from mentorship to management training.
Company Values
  • What we do is a big deal. We’re solving problems that change and save lives.
  • Powered by people. Members above all. Developing and growing others is what raises the bar.
  • No genius without grit. Be relentless. Be scrappy. Trying and failing beats not trying and changing nothing.
  • Seek the truth... but never assume you’ve found it. Be scientific.
  • Inspire & provoke. Develop and display leadership at all levels. Fight to be the best.
  • Be transparent. Give and ask for direct feedback. Be grateful for and excited by the help of others.
  • Make it right. Admit your mistakes. Then learn from them. Never build alone.