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DST Systems Director Formulary Strategy-Sacramento in San Francisco, California

The speed of technology. The influx of data. Shifting regulations. Increased customer expectations.

That's where you'll find DST, helping clients find opportunity in ever-changing and complex customer, business, and regulatory requirements. Mastering complexity is a constantly changing and evolving challenge – one that only a few people can embrace and thrive upon.

If you see your opportunity in complexity, then we are the right fit for you.

Job Description:

Organizational Overview

As an Associate with DST Pharmacy Solutions, you will be part of an organization that promotes better health outcomes for consumers through clinical and technological innovations. We accomplish this by leveraging the robust technology foundation and powerful analytic resources that are the core of DST, with industry leading clinical expertise and strategic pharmacy and healthcare solutions. You will join a team that is redefining the value of pharmacy in healthcare through the integration of advanced analytics, clinical insights and transformative digital capabilities.

Role Overview

Responsible for developing, implementing, and administering formulary and clinical management programs to support health plan program (Medicaid) utilization and financial goals. This includes managing the company's standard formulary and supporting custom formulary plans and best-in-class programs to help plans achieve 5 STAR ratings.

Responsibilities

  • Oversees the daily clinical pharmacy operations including, but not limited to, monitoring of the formulary change process using automated tools, overseeing the transition fill program, analyzing rejected and paid pharmacy claims, and managing an industry leading STAR 5 clinical program.

  • Ensures plan compliance and provides clinical and operations support in collaboration with program managers for planning, creating, maintaining and reviewing Health Plan Formularies, Prior Authorization criteria, Step Therapy criteria, and other utilization management restrictions.

  • Serves as the clinical expert to CMS Program Office and helps create, revise, and improve policies, procedures, data and new programs pertaining to related (Medicare Part D, Commercial, etc.) programs.

  • Works on a variety of issues where analysis requires evaluation of multiple factors, including business objectives and trends. Manages professional individual contributors and/or leads supervisors of a support team.

  • Participates in the interview/selection process, provides training and mentorship, offers career development guidance, and is engaged in performance management.

  • Adapts plans and priorities to address resource and operational challenges within a functional area; defines department’s operating standards.

  • Assures adherence to budgets, schedules, work plans, and performance requirements.

  • Plans and prioritizes work to meet department commitments aligned with company goals and financial responsibilities.

Qualifications

  • Bachelor’s degree and 6 years of work-related experience, or Master’s degree and 4 years of work-related experience, or 8 years equivalent work-related experience

Location:

San Francisco California

DST is an equal opportunity employer and values a diverse and inclusive workplace. All qualified candidates will receive consideration for employment without regard to age, race, color, religion, genetic information, sex, sexual orientation, gender identity, national origin, disability status, protected veteran status, or any other characteristic protected by law. For more information about Equal Opportunity in the Workplace please click here and here. DST is committed to working with and providing reasonable accommodation to job applicants with disabilities. If you are a qualified individual with a disability and need an accommodation or accessibility assistance to complete the online application, please contact us at PeopleCenter@dstsystems.com for assistance.

SS&C DST is a leading provider of specialized technology, strategic advisory, and business operations outsourcing to the financial and healthcare industries. Combining unmatched industry knowledge, critical infrastructure and service excellence, SS&C DST helps companies master complexity in the world’s most demanding industries to ensure they continually stay ahead of and capitalize on ever-changing customer, business and regulatory requirements.

We work with companies in some of the world’s most demanding industries where rapid shifts in consumer, regulatory, and technology trends are increasingly affecting how our clients do business. For them, keeping up in a landscape of constant change is becoming more and more complex. Through our technology, strategic advisory, and business improvement solutions we work with clients to help them stay ahead of and capitalize on customer, business, and regulatory change.

Mastering complexity is not an end-state. It’s a constantly changing and evolving challenge – one that only a few people can embrace and thrive upon. If you see your opportunity in complexity, then we are the right fit for you.

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