Senior Manager, Pharmacy

4 дн. назад

151.5k–202k USD / yearSeniorRemote

formulary designutilization managementclinical oversightpolicy development

Strategic hands-on pharmacy leader responsible for clinical oversight of PBM and pharmacy vendors to optimize pharmacy spend and member outcomes.

We know healthcare. Our company was founded and is still led by industry veterans who have started and grown several market-leading companies in the space.
We have raised money from top tier investors who share the same long-term vision as we do of building an industry defining company that will endure over the long run. We are well capitalized.
Our clients love us. Customer satisfaction rates among employees using health plans consistently rank above 80% – nearly 40 points above the industry average.
Our culture is unique. We tend to be non-hierarchical, merit-driven, opinionated but kind people who thrive working in a high-performance, fast-paced environment. People at care deeply about making a positive impact in the lives of the people we serve.

Serve as the primary pharmacy clinical lead for our PBM partnership, including oversight of utilization management, formulary and clinical programs
Design, implement and manage clinical programs that drive affordability, quality, and member outcomes
Provide clinical oversight of pharmacy vendors and clinical programs that improve outcomes and reduce unnecessary utilization
Own formulary design and maintenance, including tier strategy, drug placement, therapeutic class management, and clinical edit logic
Complete reviews of prior authorization decisions and appeals for specialty and non-specialty drugs
Develop and maintain policies related to clinical pharmacy and both pharmacy and medical benefit drugs
Collaborate with actuarial, finance, and product teams to inform pricing, trend modeling, pharmacy spend forecasting, and stop-loss considerations
Partner cross-functionally with product, clinical, network, actuarial and other stakeholders to ensure integrated care approaches
Ensure compliance with applicable regulatory, accreditation, and clinical governance standards, maintaining high ethical and quality standards

PharmD degree and active, unrestricted pharmacist license required
5+ years of pharmacy experience in clinical operations, utilization management, or formulary leadership
Demonstrated experience in contracting oversight or performance evaluation with PBMs or pharmacy vendors
(Bonus) Experience working within commercial level-funded health plans and/or innovative health insurers (e.g., startup or growth-stage plans)

Our unique benefits program is the gravy, i.e., the special sauce that sets our compensation package apart. In addition to standard health and wellness benefits, ’s package includes alternative medicine coverage, flexible PTO, up to 16 weeks paid parental leave, paid holidays, a 401k program, transportation perks, education reimbursement, and 2 days of paid paw-ternity leave.

Hi, we’re . Our mission is to create health benefits that actually benefit small and midsize businesses and their employees. Our innovative benefit solutions and services are developed and delivered by a diverse group of unique people. We encourage you to be your authentic self - we like you that way.
We’re seeking a strategic, hands-on pharmacy leader to own clinical oversight of our PBM and pharmacy vendors, drive formulary and UM strategy, and provide clinical expertise to shape our pharmacy affordability programs. This role bridges clinical expertise and operational execution to drive sustainable pharmacy spend and strong member outcomes.
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