Senior Manager, Pharmacy
Core
Strategic pharmacy leader owning clinical oversight of PBM and pharmacy vendors, driving formulary and utilization management (UM) strategy, and shaping pharmacy affordability programs.
Role type
Senior Manager, Pharmacy Clinical Operations
Builds
Pharmacy affordability programs, formulary strategies, and clinical utilization management programs
Domain
Health Insurance / Pharmacy Benefit Management (PBM)
Required skills
Clinical pharmacy operations, Utilization management, Formulary design, Vendor contracting oversight, Prior authorization review, Policy development, Actuarial collaboration, Regulatory compliance
Preferred skills
Commercial level-funded health plans experience, Innovative health insurer experience
Technologies
None stated
Responsibilities
Oversee utilization management and clinical programs for PBM partnerships; Design and manage clinical programs to drive affordability and member outcomes; Own formulary design including tier strategy and therapeutic class management; Review prior authorization decisions and appeals; Develop clinical pharmacy policies; Collaborate with actuarial and finance teams on spend forecasting
Seniority
Senior Manager, hands-on clinical leadership
