Clinical Pharmacist – Formulary, Quality

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

📋 Description

• Create and establish both standard and custom formularies for the designated plan.

• Lead initiatives related to formulary, prior authorization, and clinical policy.

• Assist in enhancing quality and medication-related clinical programs.

• Evaluate pharmacy and performance data.

• Formulate policies, workflows, educational resources, and communications.

• Collaborate with cross-functional teams, providers, and vendors to execute state-driven and quality-focused projects.

• Develop clinical criteria for medications.

• Suggest changes to plan design and clinical programs.

• Oversee prior authorization requests.

• Provide clinical assistance to internal departments and respond to clinical inquiries.

• Ensure effective quality controls and promote opportunities for performance enhancement in pharmacy/practice.

• Develop, implement, and sustain programs aimed at affecting DUR for Medicaid and Medicare.

• Create, implement, and uphold pharmacy department policies and procedures.

• Engage in the coordination of the Medicare MTM program.

• Support the case management team, including presentations during clinical rounds.

• Collaborate and provide cross-coverage within Formulary & Policy and Quality & Clinical Programs functions.

• Influence member access, medication safety, quality outcomes, and regulatory compliance within Indiana Medicaid pharmacy initiatives.

⛳️ Requirements

• Bachelor’s degree or advanced degree (Pharm.D., M.S.) in pharmacy.

• A minimum of 2 years of experience in mail order, retail, hospital, or managed care pharmacy, or 1 year in a pharmacy residency program.

• Valid Indiana Pharmacist license with no restrictions.

• Preferred experience in specialty drug management.

• Background in managed care, Medicaid, health plans, PBMs, formulary management, prior authorization, quality improvement, specialty drug management, and/or population health.

• Strong clinical judgment.

• Excellent written communication skills.

• Proficient in project management.

• Skilled in data analysis.

• Effective collaboration capabilities.

• Ability to handle competing priorities.

• Proficient at translating complex requirements into actionable solutions.

• Ability to identify potential risks.

• Consistently deliver accurate, audit-ready work.

• Availability to work Monday through Friday on a daytime Eastern Time schedule.

🏝️ Benefits

• Competitive salary.

• Health insurance coverage.

• 401K retirement plan.

• Stock purchase plans available.

• Tuition reimbursement options.

• Paid time off in addition to holidays.

• Flexible work arrangements including remote, hybrid, field, or office schedules.

• Additional incentives may be included in total compensation.

• Equal opportunity employer dedicated to diversity.