Simplifying the healthcare experience for clients and members.
Clinical Pharmacist, Formulary Management
Location
Florida
Posted
15 hours ago
Salary
$120K - $130K / year
Seniority
Junior
Job Description
Clinical Pharmacist, Formulary Management
Rightway
• Interpret formulary and clinical program performance data — using available dashboards and reporting tools — to identify trends and opportunities. • Translate data findings into clear, actionable clinical recommendations for clinical strategy leadership. • Support RFI and RFP submissions with data-driven clinical insights. • Actively incorporate AI tools into your daily workflow — from literature review and PA criteria drafting to formulary documentation and data summarization. • Identify opportunities where AI can streamline clinical operations tasks and help the team scale effectively. • Contribute to Rightway's evolving approach to AI adoption in clinical work; share learnings and best practices with the broader team. • Leverage AI-assisted tools to synthesize clinical literature, draft policy language, and accelerate research tasks. • Support the development, maintenance, and updating of Rightway formularies, including standard and custom drug lists. • Assist in formulary coding and collaborate with the claims platform team to ensure accuracy and functionality. • Participate in formulary testing, validation, and ongoing quality review. • Contribute to Pharmacy & Therapeutics (P&T) Committee meetings with drug evaluations, literature summaries, and formulary performance updates. • Help explore and support the implementation of non-traditional formulary designs beyond tier-based structures. • Develop, maintain, and update prior authorization criteria and clinical coverage policies. • Review PA criteria against current clinical evidence, payer benchmarks, and regulatory standards. • Support clinical reviews and provide recommendations on complex or escalated PA cases, as needed. • Assist in communicating PA criteria changes to operational teams, clients, and members. • Partner with Director of Utilization Management on the implementation and operations of clinical strategy. • Partner with Product, Data & Insights, Cost of Goods, and Client Operations teams to support formulary and clinical program implementation. • Provide clinical support to operational teams and clients during implementation and ongoing account management. • Facilitate communication and education to clients, members, and internal staff on clinical topics and formulary changes.
Job Requirements
- PharmD required; active pharmacist licensure in at least one US state.
- 1–3 years of experience in managed care pharmacy, health plan, or PBM — OR successful completion of a managed care or health-system PGY1/PGY2 residency.
- Proficient with AI tools in a professional context — you regularly use tools like ChatGPT, Claude, Copilot, or similar to accelerate and improve your work.
- Working knowledge of formulary management, PA criteria development, and managed care fundamentals.
- Comfortable reading and interpreting data (e.g., dashboards, utilization reports) and translating findings into clinical recommendations.
- Strong written and verbal communication skills; able to distill complex clinical topics for non-clinical audiences.
- Organized, detail-oriented, and capable of managing multiple projects simultaneously.
Benefits
- Compensation offered will be determined by geographic location, experience, and qualifications.
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