Key skills
Leadership
About this role
Role Overview
- Serve as the primary pharmacy clinical lead for our PBM partnership, including oversight of utilization management, formulary and clinical programs
- Design, implement and manage clinical programs that drive affordability, quality, and member outcomes
- Provide clinical oversight of pharmacy vendors and clinical programs that improve outcomes and reduce unnecessary utilization
- Own formulary design and maintenance, including tier strategy, drug placement, therapeutic class management, and clinical edit logic
- Complete reviews of prior authorization decisions and appeals for specialty and non-specialty drugs
- Develop and maintain policies related to clinical pharmacy and both pharmacy and medical benefit drugs
- Collaborate with actuarial, finance, and product teams to inform pricing, trend modeling, pharmacy spend forecasting, and stop-loss considerations
- Partner cross-functionally with product, clinical, network, actuarial and other stakeholders to ensure integrated care approaches
- Ensure compliance with applicable regulatory, accreditation, and clinical governance standards, maintaining high ethical and quality standards
Requirements
- PharmD degree and active, unrestricted pharmacist license required
- 5+ years of pharmacy experience in clinical operations, utilization management, or formulary leadership
- Demonstrated experience in contracting oversight or performance evaluation with PBMs or pharmacy vendors
Benefits
- alternative medicine coverage
- flexible PTO
- up to 16 weeks paid parental leave
- paid holidays
- 401k program
- cell phone reimbursement
- transportation perks
- education reimbursement
- 1 week of paid paw-ternity leave