Senior Managed Care Pharmacist Formulary/ Pharmacy and Therapeutics Strategy (PA Licensed)

Job Description

Job Description

Senior Managed Care Pharmacist – Formulary /   Pharmacy and Therapeutics   Strategy (PA Licensed)

Role Type: Full-Time, Regular Employee (Permanent placement on company payroll, not contract/temp)

Shift: Day Job (Monday through Friday, standard daytime business hours)

Work Arrangement: 100% Remote / Work from Home

Location: Pennsylvania (Must reside in PA)

New Hire Starting Salary Range: $107,000 – $127,000 per year base wage (After hire, pay increases can be earned, see below).

About the Opportunity

This is a permanent, full-time remote clinical leadership career opportunity within a prominent regional health insurance corporation. If selected, you will be hired  directly as a regular employee of the organization we represent, placing you on their payroll and making you eligible for full corporate benefits from day one. This is  not a temporary, contract, or "temp-to-hire" assignment. Operating in a fully virtual capacity, this role commands high clinical autonomy, a predictable schedule, and zero travel requirements.

Purpose

The  Senior Managed Care Pharmacist  provides high-level clinical governance and strategic operational management across major lines of managed care business (including Commercial, Medicare, Medicaid, and Exchange portfolios). This role goes beyond daily review cycles to drive large-scale healthcare efficiency through proactive formulary design, innovative utilization management, and compliance structuring. Serving as an independent, high-performing lead, this professional oversees complex, long-term operational projects, coordinates Pharmacy and Therapeutics (P&T) committee readiness, supports internal and external clinical audits, and mentors junior personnel to ensure exceptional quality across all pharmacy benefit programs.

Responsibilities

• Formulary Design & Operations: Assist with the clinical, operational, and regulatory management of designated lines of business, evaluating new-to-market medications promptly to submit required formulary change models.
• P&T Committee Governance: Complete extensive clinical research to prepare evidence-based recommendations for upcoming Pharmacy & Therapeutics Committee reviews, ensuring policy changes are thoroughly vetted with medical subject matter experts.
• Clinical Program Innovation: Design, scale, and implement innovative utilization management parameters, therapeutic substitution workflows, provider education materials, and cost-containment programs to manage healthcare trends.
• Regulatory Oversight & Audit Prep: Maintain deep, functional compliance workflows adhering strictly to the standards of the Pennsylvania Department of Health, CMS, and the National Committee for Quality Assurance (NCQA); actively participate in and lead preparation for internal and external corporate audits.
• Cross-Functional Account Liaison: Partner directly with employer clients, sales teams, and account managers to demystify complex pharmacy benefit plans, offering data-driven clinical recommendations during strategic meetings.
• Documentation & Communications Lifecycle: Author and revise multi-channel communication materials, including updated digital formularies, website directories, pharmacy benefit brochures, and direct provider notifications regarding compliance and drug changes.
• Mentorship & Residency Training: Serve as an advanced clinical preceptor for pharmacy residency programs and lead the technical onboarding and operational training of newly hired clinical pharmacists.
• Efficiency & Initiative Architecture: Spearhead ongoing workflow improvement initiatives, design system efficiency tools, and successfully manage diverse clinical stretch projects that extend beyond standard daily queues.

Minimum Essential Requirements

• Education: Bachelor of Science in Pharmacy and/or a Doctor of Pharmacy (Pharm.D.) degree from an accredited U.S. school of pharmacy.
• Managed Care Experience: Minimum of one (1) year of dedicated experience operating within a managed care pharmacy, pharmacy benefit management (PBM), or health insurance setting.
• Clinical Knowledge Base: Deep familiarity with therapeutic interventions, utilization management (Prior Authorization, Step Therapy, Quantity Limits), and traditional cost-containment frameworks.
• Autonomous Execution: A proven career track record of functioning as a highly independent, volume-driven team member capable of delivering accurate analytical outputs under self-directed timelines.
• Technical Aptitude: Strong data literacy and computer proficiency required for navigating pharmacy programming, electronic data management systems, and word processing suites.

Licensure, Certifications, and Clearances

• Active, unrestricted Registered Pharmacist (RPh) license in the Commonwealth of Pennsylvania is  strictly required.
• Maintenance of 30 hours of structured pharmaceutical continuing education every two-year licensing cycle.

Performance-Based Earning Potential

This position features an established clinical tier structure designed to reward strategic project execution, PBM mastery, and leadership milestones within the organization. Through sustained operational excellence, successful stewardship of primary service portfolios, and positive annual evaluations, employees have the structural opportunity to progress up to $180,000per  year over time within the corporate pay scale.

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