Director, Pharmacy Clinical Strategy – Preferred Experience in Formulary Strategy, Managed Care

PharmacistPharmacistFull TimeRemoteLeadTeam 1,001-5,000Since 30+ yearsH1B SponsorCompany SiteLinkedIn

Location

United States

Posted

2 days ago

Salary

$135.6K - $237.4K / year

Seniority

Lead

Postgraduate Degree3 yrs expExperience acceptedEnglish

Job Description

Director, Pharmacy Clinical Strategy – Preferred Experience in Formulary Strategy, Managed Care

CareSource

• Lead the strategic development of formulary management best practices & industry-leading formularies • Ensure efficient operational management • Oversee the monitoring of drug development pipeline • Educate stakeholders on drug strategies • Manage formulary and medical benefits • Negotiate direct rebates with pharmaceutical manufacturers • Develop and report on key performance indicators (KPIs) • Collaborate with other teams to communicate and educate stakeholders • Ensure compliance with regulatory and accreditation standards

Job Requirements

  • Bachelor's degree in Pharmacy required
  • Doctorate of Pharmacy (Pharm.D.) preferred
  • Three (3) years of managed care experience required
  • Two (2) years of formulary management experience in Medicare, Marketplace or Medicaid lines of business required
  • Experience working with government lines of business (Medicare, Medicare, or Marketplace) in multiple states or markets required
  • Experience participating in or leading a P&T Committee required
  • Previous managerial experience required
  • Familiarity with medical terminology and medical claims billing
  • Intermediate proficiency in Microsoft Outlook and Microsoft Word
  • Advanced proficiency in Microsoft PowerPoint and Microsoft Excel (able to create presentation-ready charts & graphs, Pivot tables/charts)

Benefits

  • Health insurance
  • 401(k) matching
  • Flexible working hours
  • Paid time off
  • Professional development opportunities
  • Bonus tied to company and individual performance
  • Substantial and comprehensive total rewards package

Related Categories

Related Job Pages

More Pharmacist Jobs

Rightangled logo

Independent Prescribing Pharmacist

Rightangled

Delivering personalised medicine.

Pharmacist2 days ago
Part TimeRemoteTeam 11-50H1B No Sponsor

- Conducting thorough assessments of patients to evaluate their health conditions and determine appropriate pharmaceutical interventions - Prescribe medications and medical devices in accordance with current legislation, guidelines, and best practices - Monitor patient responses to prescribed treatments, adjusting therapy as needed to optimise health outcomes - Provide clear and comprehensive information to patients regarding their medications, including usage, side effects, and interactions - Develop and implement individualised treatment plans for patients - Maintain accurate and detailed patient records, documenting assessments, prescriptions, and follow-up care in compliance with regulatory standards - Ensure compliance with relevant regulations, policies, and procedures related to prescribing and patient care

United Kingdom
Full TimeRemoteTeam 201-500Since 2007H1B No Sponsor

• Build and maintain relationships with nurses, physicians, and caregivers • Manage incoming phone calls and emails • De-escalate and troubleshoot issues for customers • Update consumer profiles and medication administration records • Process prescription refills • Submit electronic insurance claims and work rejections • Work with prescribers to clarify prescriptions and obtain refill approvals

Texas
Rightangled logo

Independent Prescribing Pharmacist

Rightangled

Delivering personalised medicine.

Pharmacist2 days ago
Part TimeRemoteTeam 11-50H1B No Sponsor

Role Description We are looking for two dedicated and motivated, part-time Independent Prescribers (IPs) to join our ever growing team. The ideal candidate will be a UK-qualified Independent Prescriber with a minimum of 1–2 years' experience prescribing GLP-1 weight loss medications within an online pharmacy setting. You will have excellent clinical judgement, strong communication skills, and experience working independently within a digital healthcare environment. We are recruiting for two part-time positions: - Position A: Monday to Friday, 1:00pm – 5:00pm - Position B: Monday and Tuesday 8:00am - 5:00pm, Thursday or Friday 1:00pm – 5:00pm Key Responsibilities - Conducting thorough assessments of patients to evaluate their health conditions and determine appropriate pharmaceutical interventions. - Prescribe medications and medical devices in accordance with current legislation, guidelines, and best practices. - Monitor patient responses to prescribed treatments, adjusting therapy as needed to optimise health outcomes. - Provide clear and comprehensive information to patients regarding their medications, including usage, side effects, and interactions. - Develop and implement individualised treatment plans for patients. - Maintain accurate and detailed patient records, documenting assessments, prescriptions, and follow-up care in compliance with regulatory standards. - Ensure compliance with relevant regulations, policies, and procedures related to prescribing and patient care. Qualifications - UK-qualified Independent Prescriber with an active registration with the relevant professional regulatory body. - Minimum 2-3 years' experience prescribing GLP-1 weight loss medications. - Proven experience working within an online pharmacy environment. - Strong understanding of obesity management, weight loss treatments, and remote prescribing pathways. - Excellent knowledge of clinical governance, prescribing standards, and relevant regulatory requirements. - Ability to conduct comprehensive patient assessments and make safe, evidence-based prescribing decisions. - Strong communication skills with the ability to provide clear and empathetic patient care remotely. - High level of clinical judgement and attention to detail. - Comfortable working independently in a fast-paced digital healthcare environment. - Commitment to delivering safe, compliant, and patient-centred care. Benefits - Annual discretionary performance bonus. - Access to cutting-edge technology and tools to support your work. - Employee discounts on our healthcare products. - Opportunities for personal and professional development within a forward-thinking company.

United Kingdom
Panorama logo

PSC, Medication Prior Authorization, Pharmacy

Panorama

One global community. Diverse perspectives.

Pharmacist2 days ago
Full TimeRemoteTeam 201-500Since 2009H1B Sponsor

• Submit and manage prior authorization requests for medications only, as required by insurance carriers. • Review physician medication orders, supporting clinical notes, and documentation to ensure prior authorization requests are complete and accurate. • Track medication prior authorizations from submission through approval, denial, or request for additional information. • Follow up with payers to ensure timely determinations and minimize delays in medication access. • Coordinate prescription refills in collaboration with providers and pharmacies. • Serve as the primary point of contact for pharmacies regarding medication-related questions, clarifications, and insurance requirements. • Support enrollment and coordination of patient assistance programs for medications when applicable. • Communicate with patients regarding medication-specific authorization requirements, timelines, approvals, denials, and next steps. • Identify medication prior authorization denials and coordinate appeals when appropriate. • Manage assigned work queues, tasks, and follow-ups to meet defined turnaround times. • Maintain compliance with payer requirements, HIPAA, and organizational policies.

Colorado + 13 moreAll locations: Colorado | Florida | Kansas | New Mexico | North Carolina | Oregon | Massachusetts | Michigan | Missouri | Pennsylvania | South Carolina | Texas | Virginia | Wyoming
$18 - $24 / hour