Clinical Pharmacist IV - Formulary Management

Medica•St. Louis, MO

2d•$113,400 - $170,100•Hybrid

About The Position

The Clinical Pharmacist works with internal and external stakeholders to develop and support pharmacy formulary strategy, utilization management (UM), and clinical programs. Areas of focus include formulary optimization, pharmaceutical pipeline monitoring and utilization predictions, formulary assessment, and development of UM policies for formal Pharmacy & Therapeutics (P&T) Committee approval. The role anticipates market events and incorporates local and regional trends into strategic recommendations. The position also serves as a clinical pharmacy subject matter expert and advisor and performs other duties as assigned. The role focuses on clinical and financial performance and collaborative development of success metrics for programs and initiatives. It ensures work complies with applicable state and federal regulations and requires navigating a large healthcare organization while understanding the needs of members, health systems, providers, and internal peers. This is an office role requiring onsite work an average of three days per week. Candidates may be located near the offices in Minnetonka, Minnesota; Madison, Wisconsin; St. Louis, Missouri; or Omaha, Nebraska. The full salary grade is $113,400–$194,400, with a typical hiring range of $113,400–$170,100. The position may also be eligible for incentive-plan compensation. Medica does not offer work visa sponsorship; applicants must be legally authorized to work in the United States.

Requirements

Bachelor’s degree, PharmD, or equivalent experience in a related field.
At least 5 years of progressive clinical pharmacy experience, including significant experience in managed care, a health plan, a PBM, or a payer-aligned environment.
Active pharmacist license.
Strong understanding of P&T processes, PBM and/or health plan business practices, and the competitive landscape.
Must be legally authorized to work in the United States at the time of application; employment is contingent on verification of identity and work eligibility.

Nice To Haves

Prior experience with Pharmacy and Therapeutics committee processes or formulary management at a health plan or PBM.
Strong knowledge of pharmacy benefit management, formulary execution, clinical pharmacy programs, pharmacy utilization, and factors influencing pharmacy spend and trend.
Ability to interpret pharmacy reporting and translate data into business and clinical insights; proficiency with reporting and data-analysis tools.
Ability to analyze pharmacy spend, utilization, and trend drivers and develop practical mitigation recommendations.
Knowledge of regulatory and compliance requirements affecting pharmacy services.
Strong written, verbal, presentation, and stakeholder communication skills.
Ability to collaborate in a matrixed, multidisciplinary environment and influence without direct authority.
Highly organized, able to manage multiple projects and priorities while maintaining attention to detail.
Self-starter who works effectively amid ambiguity and changing business or regulatory environments.
Creative, analytical problem solver with a demonstrated track record of achieving results.

Responsibilities

Monitor and assess the pharmaceutical drug pipeline, identify emerging therapies, and partner with analytics teams to forecast utilization and financial impacts.
Evaluate clinical literature and develop drug monographs, therapeutic class evaluations, and formulary and utilization management recommendations for P&T Committee decision-making.
Work with clinical pharmacy and analytics teams to analyze pharmacy trends, identify formulary and UM opportunities, and develop improvement strategies.
Develop and promote clinical formulary initiatives, including biosimilar optimization, market differentiation strategies, and enterprise pharmacy programs.
Participate in internal and external clinical pharmacy meetings, workgroups, and cross-functional initiatives supporting strategic, operational, and performance objectives.
Oversee and partner with stakeholders on formulary management, clinical programs, operations, regulatory matters, and compliance needs.
Serve as a clinical pharmacy subject matter expert and advisor.
Develop success metrics collaboratively and ensure work complies with applicable state and federal regulations.
Perform other duties as assigned.