Clinical Account Consultant, PBM

Clinical Account Consultant, PBM

The Clinical Account Consultant (CAC) is a clinical subject matter expert behind a portfolio of pharmacy benefit management clients. Responsibilities include turning complex claims data, clinical guidelines, and market shifts into clear, data-driven recommendations. This role partners closely with Account Executives and internal teams to improve member outcomes and pharmacy benefit performance across the client lifecycle.

Shape Clinical Strategy

• Analyze pharmacy claims, utilization, and drug trend data to surface insights and build evidence-based recommendations across formulary, utilization management, specialty, and clinical programs.
• Translate treatment guidelines, pipeline developments, and market trends into client strategy and assess its clinical impact.

Drive Clinical Program Execution & Client Delivery

• Operationalize approved recommendations with internal teams so clinical intent is accurately reflected in formulary changes, utilization management initiatives, and other pharmacy benefit enhancements.
• Review disruption analyses, clinical readiness materials, and post-go-live outputs to support accurate execution and a strong client/member experience.
• Build client-ready clinical content for quarterly business reviews, strategic reviews, renewals, finalist presentations, and other client needs then present findings and field clinical questions directly.

Build to Scale

• Partner with Account Executives, analytics, operations, product, and other internal teams to align clinical strategy with operational execution and platform capabilities.
• Contribute to the development of standardized clinical tools, templates, and best practices that raise quality, efficiency, and consistency across the team.

Additional Responsibilities

• Support general business and team needs, as required.
• Certain times of year may require meeting participation, testing, claims review, or other support outside of standard business hours, including weekends.

Required Qualifications:

• Doctor of Pharmacy (PharmD) degree from an accredited institution.
• Active pharmacist license, or ability to obtain/maintain licensure as required.
• 35 years of experience in PBM, managed care, or health plan environments.
• Strong clinical knowledge of formulary management, utilization management, clinical programs, and pharmacy trend analysis.
• Experience analyzing pharmacy claims data and translating findings into actionable clinical recommendations.
• Ability to explain complex clinical concepts clearly to both clinical and non-clinical audiences.
• Strong written and verbal communication skills.
• Highly organized and able to manage multiple priorities in a fast-paced, cross-functional environment.
• Proficiency in Microsoft Office Suite, including Excel, and experience working with large data sets.
• Ability to travel and present to small and large groups; travel is estimated not to exceed 25%.

Preferred Qualifications

• Experience supporting formulary strategies, utilization management programs, or specialty pharmacy initiatives.
• Experience contributing to client-facing clinical presentations and strategic recommendations.
• Familiarity with implementation support related to formulary strategy, disruption review, or clinically driven benefit setup.
• Experience working in a highly collaborative, matrixed environment.

New York, NY Salary Range

$140,000 - $160,000 USD

Denver, CO Salary Range

$140,000 - $160,000 USD

Charlotte, NC Salary Range

$140,000 - $160,000 USD

All employees are responsible for adherence to the Judi Health Code of Conduct including the reporting of non-compliance. This position description is designed to be flexible, allowing management the opportunity to assign or reassign duties and responsibilities as needed to best meet organizational goals.

We provide equal employment opportunities to all employees and applicants for employment and prohibit discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, medical condition, genetic information, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

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