Clinical Pharmacist IV - Formulary Management

Job Description

Job Description

Medica is a nonprofit health plan with more than a million members that serves communities in Minnesota, Nebraska, Wisconsin, Missouri, and beyond. We deliver personalized health care experiences and partner closely with providers to ensure members are genuinely cared for.   

We're a team that owns our work with accountability, makes data-driven decisions, embraces continuous learning, and celebrates collaboration — because success is a team sport. It's our mission to be there in the moments that matter most for our members and employees. Join us in creating a community of connected care, where coordinated, quality service is the norm and every member feels valued.  

The Clinical Pharmacist works in conjunction with key internal and external stakeholders to drive the strategy supporting the pharmacy formularies, utilization management (UM), and clinical programs.  

Areas of focus include formulary optimization, pharmacy pipeline monitoring/utilization predictions, formulary assessment, and new UM policy development to support formal Pharmacy & Therapeutics (P&T) Committee approvals.  The incumbent will keenly anticipate key market events and incorporate into strategic recommendations in consideration with local or regional trends. Performs other duties as assigned. 

Key Accountabilities 

• Monitor and assess the pharmaceutical drug pipeline, proactively identify key emerging therapies, and partner with analytics to forecast utilization and financial impacts.
• Evaluate clinical literature to develop drug monographs, therapeutic class evaluations, and formulary and utilization management (UM) recommendations to drive P&T committee decision making.
• Partner with internal clinical pharmacy team and analytics support to analyze pharmacy trends, identify formulary and UM opportunities, and develop strategies to support continuous improvement in formulary and UM outcomes.
• Develop and promote clinical formulary initiatives such as biosimilar optimization, market differentiation strategies, and other enterprise pharmacy programs.
• Actively participate in internal and external clinical pharmacy meetings, workgroups, and cross-functional initiatives necessary to advance strategic, operational, and performance objectives.
• Oversees and partners with key stakeholders on formulary management, clinical programs, operations, regulatory and compliance needs.
• Serves as clinical pharmacy subject matter expert and advisor.

Strategic goals are focused on clinical and financial performance, and collaborative development of success metrics to evaluate the performance of each program and initiative.  The individual in this role will ensure that such work is done in compliance with applicable state and federal regulations. 

It is important that the Clinical Pharmacist has a strong understanding of P & T processes, PBM and/or health plan business practices, and the competitive landscape. This position will need to effectively navigate a large health care organization and understand the unique needs of customers, including members, health systems, providers, and internal peers.

Required Qualifications 

• Bachelor’s Degree, PharmD, or equivalent experience in a related field

• 5+ years of progressive clinical pharmacy experience, with significant experience in managed care, health plan, PBM, or payer-aligned environments.

Required Certifications/Licensure  

• Active Pharmacist License

Preferred Qualifications 

• Prior experience with Pharmacy and Therapeutics committee processes/formulary management at a health plan or Pharmacy Benefit Manager (PBM).

• Strong knowledge of pharmacy benefit management, formulary execution, clinical pharmacy programs, pharmacy utilization, and the factors that influence pharmacy spend and trend.

• Ability to interpret pharmacy reporting and translate data into meaningful business and clinical insights; proficiency with reporting and data-analysis tools.

• Ability to analyze pharmacy spend, utilization, and trend drivers and develop practical mitigation recommendations.

• Knowledge of applicable regulatory and compliance requirements affecting pharmacy services.

• Strong written, verbal, presentation, and stakeholder communication skills.

• Effective collaborator in a matrixed, multi-disciplinary environment with the ability to influence without direct authority.

• Highly organized; able to manage multiple projects and priorities while maintaining attention to detail.

• Self-starter who works effectively through ambiguity and changing business or regulatory environments.

• Creative, analytical problem solver with a demonstrated track record of achieving results.

This position is an Office role, which requires an employee to work onsite, on average, 3 days per week. We are open to candidates located near one of the following office locations: Minnetonka, MN, Madison, WI, St. Louis, MO, or Omaha, NE. 

The full salary grade for this position is $113,400 - $194,400. While the full salary grade is provided, the typical hiring salary range for this role is expected to be between $113,400 - $170,100. Annual salary range placement will depend on a variety of factors including, but not limited to, education, work experience, applicable certifications and/or licensure, the position's scope and responsibility, internal pay equity and external market salary data.  In addition to base compensation, this position may be eligible for incentive plan compensation in addition to base salary. Medica offers a generous total rewards package that includes competitive medical, dental, vision, PTO, Holidays, paid volunteer time off, 401K contributions, caregiver services and many other benefits to support our employees.  

The compensation and benefits information is provided as of the date of this posting. Medica’s compensation and benefits are subject to change at any time, with or without notice, subject to applicable law. 

Eligibility to work in the US:  Medica does not offer work visa sponsorship for this role. All candidates must be legally authorized to work in the United States at the time of application. Employment is contingent on verification of identity and eligibility to work in the United States. 

We are an Equal Opportunity employer, where all qualified candidates receive consideration for employment indiscriminate of race, religion, ethnicity, national origin, citizenship, gender, gender identity, sexual orientation, age, veteran status, disability, genetic information, or any other protected characteristic.