Clinical Pharmacist (PBM)

The Clinical PBM Pharmacist is a key member of Curative’s PBM team, responsible for formulary strategy and maintenance, utilization management, and clinical health plan programs. This role ensures the pharmacy benefit is optimized to balance clinical efficacy, cost-effectiveness, and member access. The Clinical PBM Pharmacist collaborates with other health plan functions - including medical management, care management, population health, and compliance - to align pharmacy initiatives with the needs of the patient and organization. The ideal candidate is organized, adaptable, and thrives in an innovative, entrepreneurial, fast-paced environment.

Role Responsibilities

• Supports and manages the formulary and other PBM operations within the health plan
• Conducts clinical reviews and provides clinical guidance for formulary changes, drug exclusions, and utilization management (UM) edits to ensure evidence-based decision-making
• Monitors industry trends, FDA approvals, and market dynamics to proactively update the formulary and UM strategies
• Reviews and updates PA guidelines, plan coverage documents, RFP responses, and other materials as needed
• Participants on the Pharmacy and Therapeutics Committee, preparing clinical analyses, drug monographs, and therapeutic class reviews
• Prepares materials for the Formulary Advisory Committee including drug cost information and trends, cost savings analysis, and economic modeling
• Provides clinical support for value-based quality initiatives, such as adherence programs
• Collaborates with key stakeholders and other interdepartmental staff to communicate pharmacy strategies and clinical programs or initiatives
• Develops policies and procedures (P&Ps) and standard operating procedures (SOPs) to support the department
• Supports and manages other departmental operations

Qualifications

• Strong managed care experience with expertise in formulary design and maintenance, drug utilization management, and PA policy development
• Strong organizational skills that reflect ability to perform and prioritize multiple tasks seamlessly with excellent attention to detail
• Proficiency in data analytics, including the ability to interpret and apply pharmacy and medical claims data to drive clinical and formulary decision-making
• Demonstrated proactive approaches to problem-solving with strong decision-making capability
• Experience in population health and quality initiatives
• Strong comprehension and clinical knowledge of pharmaceutical therapies
• Highly resourceful team-player, with the ability to also act extremely effectively independently
• Demonstrated ability to achieve high performance goals and meet deadlines in a fast-paced environment
• Exceptional written and verbal communication skills, with the ability to convey complex clinical concepts to diverse audiences

Education and Experience Requirements

• Must have a Doctorate in Pharmacy (PharmD) or Bachelor of Science in Pharmacy (BSPharm)
• Must be a Registered Pharmacist (RPh) in the state of residence
• Residency training (PGY-1) preferred
• 3 years of managed care, PBM or Health plan, clinical pharmacy experience
• Proficient in Google Suite, Microsoft Office (Word, Excel, and PowerPoint)