Senior Manager, Pharmacy
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Job Description
Senior Pharmacy Manager overseeing PBM vendors, formulary strategy, and clinical programs. Driving affordable, high-quality health benefits and member outcomes at Gravie.
Responsibilities:
- Serve as the primary pharmacy clinical lead for the PBM partnership, overseeing utilization management, formulary, and clinical programs
- Design, implement, and manage clinical programs that drive affordability, quality, and member outcomes
- Provide clinical oversight of pharmacy vendors and clinical programs to improve outcomes and reduce unnecessary utilization
- Own formulary design and maintenance, including tier strategy, drug placement, therapeutic class management, and clinical edit logic
- Complete reviews of prior authorization decisions and appeals for specialty and non-specialty drugs
- Develop and maintain policies related to clinical pharmacy and pharmacy and medical benefit drugs
- Collaborate with actuarial, finance, and product teams on pricing, trend modeling, pharmacy spend forecasting, and stop-loss considerations
- Partner cross-functionally with product, clinical, network, actuarial, and other stakeholders to ensure integrated care approaches
- Ensure compliance with regulatory, accreditation, and clinical governance standards
Requirements:
- PharmD degree and active, unrestricted pharmacist license required
- 5+ years of pharmacy experience in clinical operations, utilization management, or formulary leadership
- Demonstrated experience in contracting oversight or performance evaluation with PBMs or pharmacy vendors
- Experience working within commercial level-funded health plans and/or innovative health insurers is a bonus
- Must be currently authorized to work in the United States
Benefits:
- Alternative medicine coverage
- Flexible PTO
- Up to 16 weeks paid parental leave
- Paid holidays
- 401k program
- Transportation perks
- Education reimbursement
- 2 days of paid paw-ternity leave
- Standard health and wellness benefits
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