Clinical Pharmacist, Formulary Management

🔥 6 minutes ago

🐊 Florida – Remote

🐊 Florida – Remote

💵 $120k - $130k / year

⏰ Full Time

🟢 Junior

💊 Pharmacist

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Rightway

WebsiteLinkedInAll Job Openings

201 - 500 employees

⚕️ Healthcare Insurance

☁️ SaaS

🤝 B2B

💰 $100M Series C on 2021-03

Healthcare Insurance • SaaS • B2B

Rightway is a healthcare company focused on providing care navigation and pharmacy benefits management solutions. It specializes in helping employers and health systems lower healthcare costs and improve outcomes through personalized, proactive clinical support and transparent pharmacy benefits management. Rightway offers a human-first approach, providing real-time, one-on-one support to members to help them make better healthcare decisions and navigate the complexities of healthcare systems. The company aims to reduce healthcare costs while improving employee satisfaction with healthcare services.

📋 Description

• Interpret formulary and clinical program performance data — using available dashboards and reporting tools — to identify trends and opportunities. • Translate data findings into clear, actionable clinical recommendations for clinical strategy leadership. • Support RFI and RFP submissions with data-driven clinical insights. • Actively incorporate AI tools into your daily workflow — from literature review and PA criteria drafting to formulary documentation and data summarization. • Identify opportunities where AI can streamline clinical operations tasks and help the team scale effectively. • Contribute to Rightway's evolving approach to AI adoption in clinical work; share learnings and best practices with the broader team. • Leverage AI-assisted tools to synthesize clinical literature, draft policy language, and accelerate research tasks. • Support the development, maintenance, and updating of Rightway formularies, including standard and custom drug lists. • Assist in formulary coding and collaborate with the claims platform team to ensure accuracy and functionality. • Participate in formulary testing, validation, and ongoing quality review. • Contribute to Pharmacy & Therapeutics (P&T) Committee meetings with drug evaluations, literature summaries, and formulary performance updates. • Help explore and support the implementation of non-traditional formulary designs beyond tier-based structures. • Develop, maintain, and update prior authorization criteria and clinical coverage policies. • Review PA criteria against current clinical evidence, payer benchmarks, and regulatory standards. • Support clinical reviews and provide recommendations on complex or escalated PA cases, as needed. • Assist in communicating PA criteria changes to operational teams, clients, and members. • Partner with Director of Utilization Management on the implementation and operations of clinical strategy. • Partner with Product, Data & Insights, Cost of Goods, and Client Operations teams to support formulary and clinical program implementation. • Provide clinical support to operational teams and clients during implementation and ongoing account management. • Facilitate communication and education to clients, members, and internal staff on clinical topics and formulary changes.

🎯 Requirements

• PharmD required; active pharmacist licensure in at least one US state. • 1–3 years of experience in managed care pharmacy, health plan, or PBM — OR successful completion of a managed care or health-system PGY1/PGY2 residency. • Proficient with AI tools in a professional context — you regularly use tools like ChatGPT, Claude, Copilot, or similar to accelerate and improve your work. • Working knowledge of formulary management, PA criteria development, and managed care fundamentals. • Comfortable reading and interpreting data (e.g., dashboards, utilization reports) and translating findings into clinical recommendations. • Strong written and verbal communication skills; able to distill complex clinical topics for non-clinical audiences. • Organized, detail-oriented, and capable of managing multiple projects simultaneously.

🏖️ Benefits

• Compensation offered will be determined by geographic location, experience, and qualifications.