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DUR Formulary Program Specialist I

Date:  Oct 7, 2025
Location: 

AUSTIN, TX

Join the Texas Health and Human Services Commission (HHSC) and be part of a team committed to creating a positive impact in the lives of fellow Texans. At HHSC, your contributions matter, and we support you at each stage of your life and work journey. Our comprehensive benefits package includes 100% paid employee health insurance for full-time eligible employees, a defined benefit pension plan, generous time off benefits, numerous opportunities for career advancement and more. Explore more details on the Benefits of Working at HHS webpage.

 

Functional Title: DUR Formulary Program Specialist I 
Job Title: Program Specialist I 
Agency: Health & Human Services Comm 
Department: Pharmacy Benefits Mgmt SPMP 
Posting Number: 10014 
Closing Date: 10/21/2025 
Posting Audience: Internal and External 
Occupational Category: Healthcare Support 
Salary Group: TEXAS-B-17 
Salary Range: $3,581.33 - $5,372.41 
Pay Frequency: Monthly
Shift: Day 
Additional Shift:  
Telework:  
Travel: Up to 5% 
Regular/Temporary: Regular 
Full Time/Part Time: Full time 
FLSA Exempt/Non-Exempt: Nonexempt 
Facility Location:  
Job Location City: AUSTIN 
Job Location Address: 701 W 51ST ST 
Other Locations:  
MOS Codes: 16GX,60C0,611X,612X,63G0,641X,712X,86M0,8U000,OS,OSS,PERS,YN,YNS 
 
 
 




Job Description:
The Program Specialist I (PSI) reports to the Texas Medicaid Drug Utilization Review (DUR) and Formulary Director in the Vendor Drug Program and serves as a resource for this area. The PSI provides support by researching inquires and responding to inquiries from external sources, as well as numerous state and federal agencies and programs, including the Texas Attorney General’s Office, the Federal Office of the Inspector General (OIG), the Center for Medicare and Medicaid Services (CMS), the state Kidney Health Program Services (KHC) and Children with Special Health Care Needs services program (CSHCN), HIV program, and the Legislative Budget Board (LBB). Provides administrative support for the quarterly Drug Utilization Review (DUR) Board meetings including maintaining effective working relationships with DUR Board members, plan, coordinate, and organize quarterly meetings, prepare and distribute information and materials to/from DUR Board members and stakeholders, and maintain records and documentation according to HHSC archiving policy. The PSI is responsible for the intake of the electronic Certificate of Information (eCOI) required of drug manufacturers for inclusion to the Texas Medicaid formulary including initial review of eCOI for accuracy and completeness. The PSI is responsible for archiving the eCOIs, DUR Board meeting materials, and other documents as required by the policies of VDP adhering to HHS archiving policies and procedures. The PSI is responsible for the addition, deletion, and changes in product or reformulation for single-source, over the counter (OTC), and generic drugs. This position also assists with the monitoring, maintenance, and updates of therapeutic category grouping, maximum quantity allowable, plus addressing questions on drug price issues. The PSI may assist with planning, implementing, and designing changes in the contractor’s pharmacy claims adjudication system and has primary responsibility for the production of Excel documents and reports, as required by the agencies mentioned above, based on data from the claims management system. The PSI also serves as a liaison to over 500 pharmaceutical manufacturers and over 4800 provider pharmacies, interpreting formulary department policies, rules, and regulations. This requires that program knowledge be combined with skills and “real world” experience to maintain a high level of competence and customer service. Other duties as assigned.

Essential Job Functions (EJFs):
Reviews, evaluates, tracks, and approves or denies single source, generic drug COIs and OTC drugs for coverage in the Vendor Drug Program formulary. Responsible for data entry of drug status updates that involve deletions, last lot and expiration date, and National Drug Code (NDC) changes due to product reformulation, manufacturer merger, and acquisition. Completes data entry in a timely manner. (20%)

 

Researches and responds to complaints or inquiries regarding price discrepancy, product availability, NDC changes, non-covered drugs, drug shortages, etc. Research and responds to inquiries about pricing issues, reimbursements, and prescribing provider data in the pharmacy claims system. Responsible for oversight and coordination to ensure proper follow up, documentation, and paper trails are retained for audit purposes. Responds to inquiries in a timely manner. Assists pharmacist with research of product availability and drug shortages (15%).

 

Answers inquiries and interprets Vendor Drug Formulary/Prescriber policy and procedures. Provides information to drug manufacturers, pharmacy helpdesk, Medicaid managed care health plans, pharmaceutical providers, auditors, pharmacy helpdesk staff, prescribers, recipients, other state agencies, and other HHSC program areas. Explains reimbursement formula, addition of new products and classes of non-covered products to providers, pharmaceutical companies, government agencies, and other inquirers. Keeps informed of Federal (HCFA), State Board of Pharmacy, and various state Medicaid Board’s policies and regulations for state Medicaid compliance. Assists in the oversight of correspondence between the Vendor Drug Program and pharmaceutical manufacturers. (15%)

 

Analyzes and evaluates system data from Formulary payment related files, Epocrates interface files, Conduent formulary reports, Preferred Drug List (PDL) files, and MIS reports for quality control. Reviews, research, and monitors formulary coverage, formulary audit, FDB audit trail, drug efficacy study and implementation (DESI), compound claims, formulary global changes, and HCFA quarterly reports to ensure that a high quality of program output is maintained. Interfaces with and updates Epocrates formulary system and maintains PDL statuses via interface with the PDL contractor. Shares data and serves as a resource with the LBB, Texas OAG, CMS, and the Federal OIG, as requested. (10%)

 

Prepares or assists in the preparation of administrative reports, studies, and specialized research projects, as requested internally and/or externally using various data sources. Research and compiles data, per project request. Responds to requests in a timely manner. Prepares project data in Word or Excel. Responds to projects in a timely manner. Provides data, document research, duplication, litigation support and expert witness testimony to Texas Attorney General’s office relating to matters of ongoing litigation. Responds to requests as needed. Assists the formulary SMEs in this regard to constantly access priorities and schedule workflow accordingly. (15%)

 

Participates in the testing and editing of claims administrator’s formulary/DUR software. Reviews and assists in evaluating information on service delivery system methods, outputs, and activities to identify gaps in resources and recommend improvements and produces accurate reports. Participates in oversight of the claims administrator’s designs, testing, and addresses functional issues with MIS staff. Consults with internal and external stakeholders to improve the system and make it more efficient and user friendly. Works with various contract staff to develop ad hoc reports. Other projects assigned. (10%)

 

Updates Vendor Drug Formulary, eCOI request files, and drug shortage files. May assist the DURFM Director and DUR Formulary pharmacists with special projects, assignments, legislative requests, or inquires. Provides assistance to drug manufacturers in the eCOI submission process, maintenance of the eCOI user system, and scheduling of clinical presentations. Monitors, research, and updates Formulary payment file from notifications from drug researchers, CMS, etc. Calculates unit pricing for metric decimal products. (15%)

Knowledge Skills Abilities (KSAs):
Knowledge of local, state, and federal laws relating to the Vendor Drug Program and HHS archiving policies and procedures. Thorough knowledge of public administrative procedures and management techniques. Knowledge of program planning and implementation. Thorough knowledge of Excel, MSWord, and MS Outlook.

Skill in problem analysis and resolution. Skill in Pharmaceutical calculation of metric decimal and dosage requirements. Skill in organization and time management.

Ability to devise solutions to problems and handle difficult situations tactfully. Ability to work independently. Ability to organize workloads, set priorities, and meet deadlines. Ability to gather, assemble, correlate, and analyze facts and to prepare concise reports. Ability to interpret Medicaid and Vendor Drug policies, procedures, organization and functions. Ability to develop and evaluate policies and procedures. Ability to perform essential job functions with moderate supervision. Ability to train others.

 

Registration, Licensure Requirements or Certifications:
Pharmacy Technician Certification (CPhT) highly preferred but not required.

 

Initial Selection Criteria:
Experience in a field relating to pharmacy managed care, formulary management, Vendor Drug Program, or other pharmacy-related work experience required.

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Active Duty, Military, Reservists, Guardsmen, and Veterans:

Military occupation(s) that relate to the initial selection criteria and registration or licensure requirements for this position may include, but not limited to those listed in this posting. All active-duty military, reservists, guardsmen, and veterans are encouraged to apply if qualified to fill this position. For more information please see the Texas State Auditor’s Job Descriptions, Military Crosswalk and Military Crosswalk Guide at Texas State Auditor's Office - Job Descriptions.

 

ADA Accommodations:

In compliance with the Americans with Disabilities Act (ADA), HHSC and DSHS agencies will provide reasonable accommodation during the hiring and selection process for qualified individuals with a disability. If you need assistance completing the on-line application, contact the HHS Employee Service Center at 1-888-894-4747. If you are contacted for an interview and need accommodation to participate in the interview process, please notify the person scheduling the interview.

 

Pre-Employment Checks and Work Eligibility:

Depending on the program area and position requirements, applicants selected for hire may be required to pass background and other due diligence checks.

 

HHSC uses E-Verify. You must bring your I-9 documentation with you on your first day of work. Download the I-9 Form

Telework Disclaimer:

This position may be eligible for telework.  Please note, all HHS positions are subject to state and agency telework policies in addition to the discretion of the direct supervisor and business needs.


Nearest Major Market: Austin

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