Hybrid Senior Pharmacist - Formulary & Utilization Leader

Highmark Health; Frankfort (KY); Hybrid; USD 118,000 - 197,000; Full time

Job summary

Highmark Inc. is seeking a Pharmacy Strategy Leader to oversee formulary development and utilization management, working in a hybrid model (T/W/Th) for employees within 50 miles of the corporate office.

The role partners with cross-functional teams to implement prior authorization, dose edits, and policy reviews while aligning with regulatory requirements. The ideal candidate has a PharmD or BS in Pharmacy with 5 years of related experience and strong communication skills.

Qualifications

• 5 years of related, progressive experience in the pharmacy area of specialization or completion of an accredited PGY-1 Managed Care Pharmacy Residency Program plus 2 additional years of related experience

Responsibilities

• Lead formulary and UM program initiatives to support cost savings goals.
• Develop drug formularies by monitoring FDA approvals and pipelines, assessing utilization reports, and writing drug monographs for committee review.
• Implement utilization management programs including prior authorization, dose/duration edits, quantity limits, step therapy edits, and policy development.
• Ensure regulatory compliance related to prescription drug benefit, formularies, and UM policies; represent the organization in audits as needed.
• Provide education initiatives for physicians, clients, and members to promote formulary strategies and UM programs.
• Manage department projects and drive process improvements; mentor junior staff as needed.

Skills

Managed care pharmacy

Communication skills

MS Office & Databases

Problem identification

Root cause analysis

Education

Doctor of Pharmacy (PharmD) or BS in Pharmacy

Job description

Highmark Inc. is seeking a Pharmacy Strategy Leader to oversee formulary development and utilization management, working in a hybrid model (T/W/Th) for employees within 50 miles of the corporate office.

The role partners with cross-functional teams to implement prior authorization, dose edits, and policy reviews while aligning with regulatory requirements. The ideal candidate has a PharmD or BS in Pharmacy with 5 years of related experience and strong communication skills.