Senior Manager, Pharmacy

Key Responsibilities

• Serve as the primary pharmacy clinical lead for our PBM partnership, including oversight of utilization management, formulary and clinical programs
• Design, implement and manage clinical programs that drive affordability, quality, and member outcomes
• Provide clinical oversight of pharmacy vendors and clinical programs that improve outcomes and reduce unnecessary utilization
• Own formulary design and maintenance, including tier strategy, drug placement, therapeutic class management, and clinical edit logic
• Complete reviews of prior authorization decisions and appeals for specialty and non-specialty drugs
• Develop and maintain policies related to clinical pharmacy and both pharmacy and medical benefit drugs
• Collaborate with actuarial, finance, and product teams to inform pricing, trend modeling, pharmacy spend forecasting, and stop-loss considerations
• Partner cross-functionally with product, clinical, network, actuarial and other stakeholders to ensure integrated care approaches
• Ensure compliance with applicable regulatory, accreditation, and clinical governance standards, maintaining high ethical and quality standards

Key Requirements

• PharmD degree and active, unrestricted pharmacist license required
• 5+ years of pharmacy experience in clinical operations, utilization management, or formulary leadership
• Demonstrated experience in contracting oversight or performance evaluation with PBMs or pharmacy vendors
• (Bonus) Experience working within commercial level-funded health plans and/or innovative health insurers (e.g., startup or growth-stage plans)

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