Manager Clinical Pharmacy

The Manager, Clinical Pharmacy Services provides strategic leadership and operational oversight for formulary management, utilization management, and clinical pharmacy programs. This role is accountable for achieving market‑level clinical, financial, quality, and regulatory outcomes. The Manager leads and develops a team of clinical pharmacists, partners cross‑functionally with enterprise stakeholders, and drives initiatives that enhance patient safety, optimize medication use, and improve customer experience.

Responsibilities:

·       Lead the execution and support the development of market‑level clinical pharmacy strategies aligned with enterprise priorities.

·       Provide clinical leadership for enterprise‑wide formulary strategy and medical benefit drug policy development.

·       Ensure clinically appropriate and cost-effective formulary by providing appropriate drug review and formulary placement based on clinical and financial data. 

·       Develop and implement direct patient care strategy and clinical pharmacy programs for the market

·       Drives compliance in the delivery of clinical pharmacy services

·       Drives market pharmacy financial performance

·       Drives the execution of multiple business plans and projects, ensuring business needs are being met

·       Promotes and supports company policies, procedures, mission, values, and standards of ethics and integrity

·       Represent Clinical Pharmacy Services in cross‑functional planning meetings and customer‑facing engagements.

·       Provides supervision and development opportunities for associates

·       Ensure accuracy, integrity, and timeliness of formulary submissions and medical necessity policy reviews.

·       Ensures compliance with all required regulatory guidelines

Clinical Lead

·       Oversee the management of the IBX Pharmacy and Therapeutics Committee

·       Formulary Management Oversight (tasks executed by 2 pharmacists)

·       Oversee medical necessity policy management and strategy

·       Ensure readiness for internal/external audits and support accreditation maintenance (CMS, URAC, NCQA).

·       Ensure clinical integrity of medical necessity reviews

Strategic

·       Oversee integration of clinical programs with digital platforms and analytics tools to support clinical decision‑making.

·       Identify strategic opportunities to maintain cost-effectiveness and improve clinical effectiveness

·       Coordinate Strategic positioning of clinical programs including clinical customer support

·       Coordinate Quality and Product initiatives

Qualifications:

·       Doctor of Pharmacy or Bachelor of Science Degree in Pharmacy plus 7+ years of relevant clinical experience

·       Active State Pharmacy License

·       More than 5 years practice experience in a managed care or corporate setting

·       Experience supporting Medicare STAR ratings or quality improvement programs.

Preferred experience:

·     Current knowledge and expertise in clinical pharmacology, disease management and managed care

·     Minimum 5-7 years of leadership or team lead experience in managed care, clinical pharmacy programs, or formulary management.

·     Experience with clinical analytics, pharmacy benefit design, or affordability initiatives.

·     Self-management Skills – self-motivated, organized, detail oriented and manages time and resources effectively.  Must be able to work independently in a collaborative environment, be self-directed and possess excellent organizational and time management skills

·     Computer/Technology Competency: Proficient in use of Microsoft Word, Excel, and Outlook

·     Strong interpersonal, communication, administrative, leadership, problem solving and decision-making skills

·     Medicare related: Working knowledge and understanding of CMS Medicare Part D requirements