Manager, Formulary Design and Strategy

CareSource

Manager leading formulary design and strategy at CareSource, creating best practices and competitive management strategies. Overseeing operational management and collaboration with stakeholders for improved member health outcomes.

Posted 6/19/2026full-timeRemote • 🇺🇸 United StatesMid-LevelSenior💰 $113,000 - $197,700 per yearWebsite

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Hard Skills

formulary managementmanaged caredata analysiscost of care savingsperformance indicatorsclinical policy developmentdrug utilization reviewprocess improvementtraining and coachingnegotiation

Soft Skills

leadershipcollaborationcommunicationmotivationprofessional developmentpresentation skillsstakeholder educationteam managementstrategic thinkingproblem-solving

Tools & Technologies

Microsoft WordMicrosoft OutlookMicrosoft PowerPointMicrosoft Excel

Certifications & Qualifications

Bachelor’s Degree in PharmacyPharmacy Degree (PharmD)Master’s in Business Administration

Industry Keywords

P&T CommitteeValue Assessment CommitteeMedicaidMedicareExchangestate-mandated formulariesclinical policiesdrug management techniquesformulary change processpharmaceutical manufacturers

About the role

Key responsibilities & impact

Leads the creation of formulary design best practices and industry-leading, market-competitive formulary management strategies across all CareSource lines of business and markets
Manages the CareSource RXInnovations Value Assessment Committee including preparation of meeting materials and presentations, and education of stakeholders following committee meetings
Directs and ensures the efficient operational management of the formulary management team with emphasis on execution, outcomes, continual improvement and performance enhancement
Oversees the monitoring of and educates stakeholders on the drug development pipeline and strategies we will employ to appropriately manage new and existing drugs
Works with appropriate business partners to ensure accurate and timely implementation of formulary changes by PBM
Monitors the formulary change process to minimize member disruption but drive value and better member outcomes
Supports leadership in direct rebating decisions and negotiations in collaboration with pharmaceutical manufacturers
Creates, monitors, and reports monthly on key performance indicators (KPIs) related to formulary management, including but not limited to cost and member, provider and/or drug utilization
Ensures team collaboration with Clinical Program Managers to create and improve programs that drive better member health outcomes
Leads the identification, quantification and measurement of total cost of care savings opportunities related to formulary management and other drug management techniques
Collaborates with other teams to communicate and educate members, providers, pharmacies, and internal business partners on formulary, prior authorizations, specialty drugs and other initiatives
Ensures regulatory and compliance guidelines are met for Medicaid, Medicare, Exchange and future lines of related to formulary management and the development of clinical policies and criteria
Develops policies, trainings, and procedures to ensure compliance with new and existing regulations and accreditation standards
Analyzes data regularly to identify process improvement opportunities relating to formulary management, as well as clinical policy and criteria development
Accountable for motivating, hiring, training, coaching, professional development, succession planning, performance appraisals, and disciplinary actions of staff
Advises and precepts APPE students and residents
Participates in department and team initiatives and projects
Participates in relevant pharmacy research projects and educational programs

Requirements

What you’ll need

Bachelor’s Degree in Pharmacy or Pharmacy Degree (PharmD) required
Master’s in Business Administration or related is preferred
Minimum of five (5) years of managed care experience required
Minimum of two (2) years of formulary management experience
Experience participating in or leading a P&T, Value Assessment Committee, or Drug Utilization Review Board required
Previous management experience is required
Experience working with multiple lines of business (commercial or government lines of business (Medicare, Medicare, or Marketplace)) or multiple states is preferred
Experience with state-mandated formularies preferred
Proficiency in Microsoft Word and Outlook and advanced proficiency in PowerPoint and Excel
Familiarity with medical terminology

Benefits

Comp & perks

Bonuses tied to company and individual performance
Substantial and comprehensive total rewards package