Clinical Account Consultant, PBM
About The Position
The Clinical Account Consultant (CAC) is a clinical subject matter expert supporting a portfolio of pharmacy benefit management clients. The role turns complex claims data, clinical guidelines, and market shifts into clear, data-driven recommendations and partners closely with Account Executives and internal teams to improve member outcomes and pharmacy benefit performance across the client lifecycle. The consultant analyzes pharmacy claims, utilization, and drug trend data; develops evidence-based recommendations related to formulary, utilization management, specialty, and clinical programs; and assesses the clinical impact of treatment guidelines, pipeline developments, and market trends. The role helps operationalize approved recommendations, reviews clinical readiness and post-go-live materials, and develops and presents client-ready content for business reviews, strategic reviews, renewals, finalist presentations, and other client needs. The position also collaborates with analytics, operations, product, and other teams to align clinical strategy with execution and platform capabilities, and contributes to standardized clinical tools, templates, and best practices. Travel is estimated not to exceed 25%. Certain times of year may require work outside standard business hours, including weekends.
Requirements
- Doctor of Pharmacy (PharmD) degree from an accredited institution.
- Active pharmacist license, or ability to obtain and maintain licensure as required.
- 3–5 years of experience in PBM, managed care, or health plan environments.
- Strong clinical knowledge of formulary management, utilization management, clinical programs, and pharmacy trend analysis.
- Experience analyzing pharmacy claims data and translating findings into actionable clinical recommendations.
- Ability to explain complex clinical concepts clearly to clinical and non-clinical audiences.
- Strong written and verbal communication skills.
- Highly organized and able to manage multiple priorities in a fast-paced, cross-functional environment.
- Proficiency in Microsoft Office Suite, including Excel, and experience working with large data sets.
- Ability to travel and present to small and large groups; travel is estimated not to exceed 25%.
Nice To Haves
- Experience supporting formulary strategies, utilization management programs, or specialty pharmacy initiatives.
- Experience contributing to client-facing clinical presentations and strategic recommendations.
- Familiarity with implementation support related to formulary strategy, disruption review, or clinically driven benefit setup.
- Experience working in a highly collaborative, matrixed environment.
Responsibilities
- Analyze pharmacy claims, utilization, and drug trend data to identify insights and develop evidence-based recommendations across formulary, utilization management, specialty, and clinical programs.
- Translate treatment guidelines, pipeline developments, and market trends into client strategy and assess their clinical impact.
- Operationalize approved recommendations with internal teams to ensure clinical intent is reflected accurately in formulary changes, utilization management initiatives, and other pharmacy benefit enhancements.
- Review disruption analyses, clinical readiness materials, and post-go-live outputs to support accurate execution and a strong client and member experience.
- Develop client-ready clinical content for quarterly business reviews, strategic reviews, renewals, finalist presentations, and other client needs.
- Present clinical findings to clients and respond to clinical questions.
- Partner with Account Executives, analytics, operations, product, and other internal teams to align clinical strategy with operational execution and platform capabilities.
- Contribute to standardized clinical tools, templates, and best practices that improve team quality, efficiency, and consistency.
- Support general business and team needs as required.
- Participate in meetings, testing, claims review, or other support outside standard business hours, including weekends, during certain times of year.
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What This Job Offers
Job Type
Full-time
Education Level
Ph.D. or professional degree
