Clinical Pharmacist, Formulary Management

This is a fully remote position, open to applicants in Florida.

📋 Description

• Analyze formulary and clinical program performance data utilizing available dashboards and reporting tools to uncover trends and potential opportunities.

• Convert data findings into concise, actionable clinical recommendations for clinical strategy leadership.

• Assist with RFI and RFP submissions by providing data-driven clinical insights.

• Integrate AI tools into your daily tasks — from conducting literature reviews and drafting PA criteria to formulating documentation and summarizing data.

• Identify areas where AI can enhance clinical operations tasks and assist the team in scaling effectively.

• Contribute to Rightway's progressive strategy for AI integration in clinical work; share insights and best practices with the wider team.

• Utilize AI-assisted tools to synthesize clinical literature, formulate policy language, and expedite research activities.

• Aid in the development, maintenance, and updating of Rightway formularies, including both standard and custom drug lists.

• Support formulary coding and work with the claims platform team to ensure precision and functionality.

• Engage in formulary testing, validation, and continuous quality review.

• Participate in Pharmacy & Therapeutics (P&T) Committee meetings, providing drug evaluations, literature summaries, and formulary performance updates.

• Assist in exploring and implementing non-traditional formulary designs beyond tier-based structures.

• Develop, maintain, and revise prior authorization criteria and clinical coverage policies.

• Review PA criteria in light of current clinical evidence, payer benchmarks, and regulatory standards.

• Support clinical reviews and offer recommendations on complex or escalated PA cases as necessary.

• Help communicate changes in PA criteria to operational teams, clients, and members.

• Collaborate with the Director of Utilization Management on executing and managing clinical strategy.

• Work alongside Product, Data & Insights, Cost of Goods, and Client Operations teams to facilitate formulary and clinical program implementation.

• Provide clinical support to operational teams and clients throughout the implementation and ongoing account management process.

• Facilitate communication and education regarding clinical topics and formulary changes to clients, members, and internal staff.

⛳️ Requirements

• PharmD is required; active pharmacist licensure in at least one U.S. state is necessary.

• 1–3 years of experience in managed care pharmacy, health plans, or PBM — OR successful completion of a managed care or health-system PGY1/PGY2 residency.

• Proficient in using AI tools in a professional setting — you regularly employ tools such as ChatGPT, Claude, Copilot, or similar to enhance and streamline your work.

• Familiarity with formulary management, PA criteria development, and the fundamentals of managed care.

• Comfortable with reading and interpreting data (e.g., dashboards, utilization reports) and translating findings into clinical recommendations.

• Excellent written and verbal communication skills; capable of simplifying complex clinical topics for non-clinical audiences.

• Organized, detail-oriented, and adept at managing multiple projects concurrently.

🏝️ Benefits

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