Clinical Pharmacy Manager, Formulary Strategy

🔥 20 hours ago

🌵 Arizona, Florida, +15 more states – Remote

🌵 Arizona – Remote 🐊 Florida – Remote 🌽 Illinois – Remote 🌾 Iowa – Remote 🌪️ Kansas – Remote 🐎 Kentucky – Remote 🌾 Nebraska – Remote 🌾 North Dakota – Remote 🌪️ Oklahoma – Remote 🚗 Michigan – Remote ❄️ Minnesota – Remote 🏰 Missouri – Remote 🗿 South Dakota – Remote 🎸 Tennessee – Remote 🤠 Texas – Remote ⚔️ Virginia – Remote 🧀 Wisconsin – Remote

💵 $113.4k - $170.1k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

💊 Pharmacist

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 0%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

Apply Now

Find Similar Remote Jobs

Set Up Email Alert For New Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

Medica

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1975

🏥 Healthcare

🛡️ Insurance

⚕️ Healthcare Insurance

Healthcare • Insurance • Healthcare Insurance

Medica is a nonprofit health plan and insurer with over 50 years of experience that provides individual & family plans, Medicare, Medicaid, and employer-provided health plans. It offers member services and tools for finding providers, managing benefits and claims, wellness programs, and community-focused initiatives through the Medica Foundation to advance health equity.

📋 Description

• Lead development, maintenance, and oversight of enterprise clinical pharmacy positions across all drug classes and lines of business • Establish and oversee clinical position strategy, including specialty and emerging therapies • Ensure consistency, transparency, and evidence-based rationale across formulary coverage, utilization management criteria, and clinical policy decisions • Provide governance oversight for clinical escalations, complex coverage questions, and exception resolution • Coordinate alignment among clinical pharmacy, utilization management operations, finance, actuarial, and PBM partners • Support P&T and Formulary Value Committee governance forums by elevating issues, risks, and recommendations • Lead pipeline assessment and drug readiness activities for new molecular entities, biosimilars, expanded indications, and high-impact therapies • Develop drug evaluations, monographs, therapeutic class reviews, comparative effectiveness assessments, and financial/utilization considerations for committee meetings • Develop evidence-based recommendations and serve as a subject matter expert during committee discussions and executive escalations • Lead therapeutic class strategy reviews using clinical evidence, treatment guidelines, real-world data, and safety considerations • Oversee custom policy writing for pharmacy and medical benefit drugs • Lead development and maintenance of utilization management criteria, including prior authorization, step therapy, quantity limits, and coverage limitations • Conduct policy gap analyses and ensure timely, clinically appropriate criteria updates • Manage internal and external stakeholder relationships • Provide direction, mentorship, and clinical oversight to pharmacists and analysts • Coordinate workload, prioritization, and resource allocation • Support knowledge development, standard work, and process improvement within clinical governance

🎯 Requirements

• Bachelor's degree in Pharmacy or PharmD required • 5+ years of related work experience in health plan pharmacy, PBM clinical management, or related clinical leadership role beyond degree • 1+ years of leadership experience • Active Pharmacist license required • Demonstrated experience with clinical policy and UM criteria development • Experience with P&T Committee support and presentations • Experience with drug evaluations and therapeutic class reviews • Experience working within regulated environments, including Medicare and/or Medicaid • Board certification, such as BCPS or another relevant specialty, preferred • Experience in plan-led or hybrid PBM models preferred • Familiarity with accreditation and regulatory frameworks, such as CMS and NCQA • Leadership experience overseeing clinical pharmacists or matrixed teams • Clinical credibility and sound judgment • Strong governance mindset and attention to consistency • Ability to translate evidence into practical, defensible clinical positions • Executive-level presentation and communication skills • Collaborative, cross-functional leadership • Must be legally authorized to work in the United States at the time of application • Medica does not offer work visa sponsorship for this role

🏖️ Benefits

• Competitive medical, dental, and vision coverage • Paid time off (PTO) • Holidays • Paid volunteer time off • 401K contributions • Caregiver services • Incentive plan compensation may be available in addition to base salary