Clinical Pharmacy Manager, Formulary Strategy

This is a fully remote position, open to applicants in Arizona, +16 more states.

📋 Description

• Direct the development, maintenance, and supervision of enterprise clinical pharmacy roles across all drug classes and lines of business.

• Formulate and manage clinical position strategies, encompassing specialty and emerging therapies.

• Ensure uniformity, transparency, and evidence-based justifications across formulary coverage, utilization management criteria, and clinical policy decisions.

• Provide governance oversight for clinical escalations, intricate coverage inquiries, and exception resolutions.

• Facilitate alignment among clinical pharmacy, utilization management operations, finance, actuarial, and PBM partners.

• Assist P&T and Formulary Value Committee governance forums by highlighting issues, risks, and recommendations.

• Spearhead pipeline assessments and drug readiness activities for new molecular entities, biosimilars, expanded indications, and high-impact therapies.

• Create drug evaluations, monographs, therapeutic class reviews, comparative effectiveness assessments, and financial/utilization considerations for committee meetings.

• Develop evidence-based recommendations and act as a subject matter expert during committee discussions and executive escalations.

• Lead therapeutic class strategy reviews utilizing clinical evidence, treatment guidelines, real-world data, and safety considerations.

• Supervise custom policy writing for both pharmacy and medical benefit drugs.

• Oversee the development and upkeep of utilization management criteria, including prior authorization, step therapy, quantity limits, and coverage restrictions.

• Conduct policy gap analyses and guarantee timely, clinically appropriate updates to criteria.

• Manage relationships with internal and external stakeholders.

• Provide guidance, mentorship, and clinical oversight to pharmacists and analysts.

• Coordinate workload, prioritization, and resource allocation.

• Promote knowledge development, standard work, and process improvement within clinical governance.

⛳️ Requirements

• A Bachelor's degree in Pharmacy or PharmD is mandatory.

• A minimum of 5 years of relevant work experience in health plan pharmacy, PBM clinical management, or a related clinical leadership role beyond the degree.

• At least 1 year of leadership experience is required.

• An active Pharmacist license is essential.

• Proven experience in clinical policy and UM criteria development.

• Experience in supporting and presenting for P&T Committees.

• Familiarity with drug evaluations and therapeutic class reviews.

• Experience working in regulated environments, including Medicare and/or Medicaid.

• Board certification, such as BCPS or another relevant specialty, is preferred.

• Experience in plan-led or hybrid PBM models is preferred.

• Knowledge of accreditation and regulatory frameworks, such as CMS and NCQA.

• Leadership experience in overseeing clinical pharmacists or matrixed teams.

• Clinical credibility and sound judgment.

• Strong governance mindset with attention to consistency.

• Ability to convert evidence into practical, defensible clinical positions.

• Excellent executive-level presentation and communication skills.

• Collaborative cross-functional leadership skills.

• Must be legally authorized to work in the United States at the time of application.

• Medica does not provide work visa sponsorship for this position.

🏝️ Benefits

• Comprehensive 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 the base salary.