Clinical Pharmacist - Formulary & Policy Expert

HMSA; Honolulu (HI); On-site; USD 105,000 - 140,000; Full time

Job summary

HMSA in Honolulu, HI, is seeking a Clinical Program Support professional to help implement and manage formulary, utilization management, and clinical policy programs across an assigned line of business.

You will analyze the clinical impact of program changes, ensure alignment with clinical strategy, and communicate opportunities to improve member outcomes and financial performance. Collaboration with data analysts and cross-functional teams will be essential to success.

Responsibilities

• Support implementation and ongoing management of formulary, utilization management, and clinical policy programs within an assigned line of business.
• Evaluate clinical implications of pharmacy program changes and emerging utilization trends.
• Maintain alignment between clinical strategy and line-of-business needs.
• Identify and communicate opportunities to improve clinical and financial outcomes.
• Conduct clinical reviews of medications, therapeutic classes, and utilization patterns.
• Formulary evaluations and clinical recommendation development.
• Evaluate utilization management programs and identify opportunities for refinement.
• Development, implementation, and maintenance of clinical policies and coverage criteria.
• Review pharmacy utilization data, emerging trends, and clinical outcomes to identify opportunities for intervention.
• Evaluate the clinical impact of new therapies, utilization patterns, and pharmacy initiatives.
• Development of recommendations designed to improve member outcomes and manage pharmacy trend.
• Collaborate with Data Analysts to interpret findings and evaluate potential opportunities.
• Partner with Pharmacy Operations to support operational implementation of clinical decisions and policy updates.
• Collaborate with Pharmacy Solutions on strategic initiatives and readiness planning.
• Support Pharmacy Performance with clinical interpretation of PBM programs, formulary changes, and utilization management performance.
• Serve as a clinical resource for internal stakeholders and external vendor partners.
• Support preparation of materials and recommendations for Pharmacy & Therapeutics (P&T) Committee activities.
• Provide clinical consultation regarding formulary, utilization management, and pharmacy program questions.
• Participate in cross-functional initiatives requiring pharmacy clinical expertise.
• Assist with regulatory, accreditation, and compliance activities impacting pharmacy clinical programs.

Job description

HMSA in Honolulu, HI, is seeking a Clinical Program Support professional to help implement and manage formulary, utilization management, and clinical policy programs across an assigned line of business.

You will analyze the clinical impact of program changes, ensure alignment with clinical strategy, and communicate opportunities to improve member outcomes and financial performance. Collaboration with data analysts and cross-functional teams will be essential to success.