Clinical Pharmacist, Formulary Services

Abarca Health•San Juan, PR

7h•Hybrid

About The Position

The Clinical Pharmacist for Formulary Services develops and implements Medicare, Medicaid, and Exchange formulary programs while ensuring compliance with external regulatory guidelines. The role independently resolves adjudication and processing issues, provides client-facing demonstrations of the PBM configuration platform, and leads configuration setup for new client implementations and changes. The position provides consultative support to clients and internal teams; monitors configuration-team workload; identifies inventory-management improvements; and collaborates across configuration teams and business units. It also supports client benefit operations calls and meetings, maintains an in-depth understanding of the Darwin adjudication platform, contributes clinical recommendations and presentations to the Pharmacy & Therapeutics Committee, participates in audits and Medicare initiatives, and leads process improvements, documentation, and team training. Abarca offers a flexible hybrid work model requiring certain on-site workdays for the Puerto Rico location only. The schedule must accommodate the business needs of clients and team members, and the position may require on-call availability during evenings, weekends, and holidays when operational demands call for it.

Requirements

Doctoral Degree in Pharmacy.
Current, active pharmacy license.
At least 3 years of experience with formulary management within clinical operations and pharmacy benefit management.
Experience working within clinical scenarios.
Excellent oral and written communication skills.
Availability to work in a specified time zone or schedule that accommodates client and team business needs.
Ability to access and navigate each department at the organization’s facilities.
Ability to perform sedentary work primarily involving sitting or standing.

Nice To Haves

Experience with pharmacy benefit management clinical operations and Medicare Part D.
Master’s Degree.

Responsibilities

Develop and implement Medicare, Medicaid, and Exchange formulary programs.
Monitor regulatory guidance and make timely operational adjustments to maintain compliance.
Research and resolve adjudication and processing issues, including identifying root causes, determining impact, and recommending corrective actions.
Own assigned project-based work.
Present demonstrations of the PBM configuration platform to clients and prospective clients.
Lead configuration setup for new Medicare, Medicaid, Commercial, and Employer client implementations and configuration changes for existing clients.
Provide consultative support to clients and internal teams.
Monitor and distribute configuration-team workload assignments.
Identify inventory-management opportunities and solutions that improve efficiency and configuration standards.
Coordinate with configuration teams and other business units to complete configuration work.
Manage client benefit operations calls, key client meetings, and requests; capture discussion topics and action items and share input and solutions to address client needs.
Maintain an in-depth understanding of Darwin adjudication-platform logic to configure designs accurately to client requirements.
Participate in the Pharmacy & Therapeutics Committee by preparing presentations and clinical recommendations for new drugs.
Research and stay informed about current and emerging trends in formulary and benefit design.
Participate in government and internal audits.
Engage in CMS Medicare STAR initiatives and clinical programs, as well as Medicare Plan Finder and PDE processes.
Lead process-improvement efforts and make recommendations.
Develop process documentation, including Policies and Procedures, for Benefit Administration operations.
Support training for new team members on configuration setup and standardized quality procedures.