Clinical Pharmacist IV - Formulary Management

Health insurance that's with you, every step of the way.•Minnetonka, MN

2d•Hybrid

About The Position

The Clinical Pharmacist works with internal and external stakeholders to advance pharmacy formulary strategy, utilization management (UM), and clinical programs. Areas of focus include formulary optimization, pharmacy pipeline monitoring and utilization predictions, formulary assessment, and development of new UM policies for formal Pharmacy & Therapeutics (P&T) Committee approval. The role anticipates important market events and incorporates them into strategic recommendations while considering local and regional trends. The position serves as a clinical pharmacy subject matter expert and advisor, partnering with stakeholders on formulary management, clinical programs, operations, regulatory matters, and compliance. Its strategic goals include clinical and financial performance and collaboratively developing success metrics to evaluate programs and initiatives. Work must comply with applicable state and federal regulations. The role requires understanding P&T processes, PBM and/or health plan business practices, and the competitive landscape, as well as navigating a large health care organization and understanding the needs of members, health systems, providers, and internal peers. Other duties may be assigned. This is an office role requiring onsite work an average of three days per week. Candidates may be located near the Minnetonka, Minnesota; Madison, Wisconsin; St. Louis, Missouri; or Omaha, Nebraska office. The full salary grade is $113,400–$194,400, with a typical hiring range of $113,400–$170,100. Placement depends on factors including education, work experience, certifications or licensure, scope and responsibility, internal pay equity, and external market data. The role may also be eligible for incentive plan compensation. Medica does not offer work visa sponsorship; candidates must be legally authorized to work in the United States at the time of application.

Requirements

Bachelor’s degree, PharmD, or equivalent experience in a related field.
At least 5 years of progressive clinical pharmacy experience, with significant experience in managed care, a health plan, a PBM, or a payer-aligned environment.
Active pharmacist license.

Nice To Haves

Prior experience with Pharmacy and Therapeutics Committee processes or formulary management at a health plan or Pharmacy Benefit Manager.
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 meaningful 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 effectively in a matrixed, multidisciplinary environment and influence without direct authority.
Strong organizational skills and ability to manage multiple projects and priorities while maintaining attention to detail.
Self-starter who works effectively through 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 to support P&T Committee decision-making.
Partner with clinical pharmacy and analytics teams to analyze pharmacy trends, identify formulary and UM opportunities, and develop strategies for continuous improvement.
Develop and promote clinical formulary initiatives, including biosimilar optimization, market differentiation strategies, and other enterprise pharmacy programs.
Participate in internal and external clinical pharmacy meetings, workgroups, and cross-functional initiatives that advance strategic, operational, and performance objectives.
Partner with stakeholders on formulary management, clinical programs, operations, regulatory matters, and compliance.
Serve as a clinical pharmacy subject matter expert and advisor.
Collaboratively develop success metrics and evaluate the clinical and financial performance of programs and initiatives.
Ensure work complies with applicable state and federal regulations.
Perform other duties as assigned.