Senior Manager, Pharmacy

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

📋 Description

• Act as the primary clinical leader for the pharmacy benefit management (PBM) partnership, managing utilization, formulary, and clinical initiatives.

• Develop, execute, and oversee clinical programs aimed at enhancing affordability, quality, and member outcomes.

• Provide clinical supervision of pharmacy vendors and clinical programs to optimize outcomes and minimize unnecessary utilization.

• Take charge of formulary design and maintenance, including tier strategy, drug placement, therapeutic class management, and clinical edit logic.

• Conduct reviews of prior authorization decisions and appeals for both specialty and non-specialty medications.

• Formulate and uphold policies concerning clinical pharmacy and drugs covered under pharmacy and medical benefits.

• Collaborate with actuarial, finance, and product teams on pricing strategies, trend modeling, pharmacy expenditure forecasting, and stop-loss considerations.

• Work collaboratively with product, clinical, network, actuarial, and other stakeholders to ensure cohesive care approaches.

• Maintain compliance with regulatory, accreditation, and clinical governance standards.

⛳️ Requirements

• A PharmD degree and an active, unrestricted pharmacist license are mandatory.

• A minimum of 5 years of experience in pharmacy clinical operations, utilization management, or formulary leadership is required.

• Proven experience in oversight of contracting or performance evaluation with PBMs or pharmacy vendors.

• Experience within commercial level-funded health plans and/or innovative health insurers is considered a plus.

• Must be legally authorized to work in the United States.

🏝️ Benefits

• Coverage for alternative medicine.

• Flexible paid time off (PTO).

• Up to 16 weeks of paid parental leave.

• Paid holidays.

• 401k retirement plan.

• Transportation benefits.

• Education reimbursement.

• Two days of paid paw-ternity leave.

• Comprehensive health and wellness benefits.