Pharmacy Clinical Lead - Formulary, UM & PBM (Flexible PTO)

Limelight Health; Minneapolis (MN); On-site; USD 150,000 - 190,000; Full time

Benefits offered by this job

Parental leave (up to 16 weeks)?

401k program

Transportation perks

Education reimbursement

Paw-ternity leave

Job summary

Gravie seeks a strategic, hands-on pharmacy leader to own clinical oversight of our PBM and pharmacy vendors, driving formulary strategy and clinical programs that improve affordability and member outcomes.

This role blends clinical expertise with operational execution, partnering with actuarial, finance and product teams to inform pricing, spend forecasting, and stop-loss considerations across the organization.

Qualifications

• 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.
• Bonus: experience with commercial level-funded health plans and/or innovative health insurers.

Responsibilities

• Serve as the primary pharmacy clinical lead for our PBM partnership, including oversight of 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 that 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 both pharmacy and medical benefit drugs.
• Collaborate with actuarial, finance, and product teams to inform 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 applicable regulatory, accreditation, and clinical governance standards, maintaining high ethical and quality standards.

Skills

Strategic leadership

Cross-functional collaboration

Clinical leadership

Education

PharmD degree

Active pharmacist license

Job description

Gravie seeks a strategic, hands-on pharmacy leader to own clinical oversight of our PBM and pharmacy vendors, driving formulary strategy and clinical programs that improve affordability and member outcomes.

This role blends clinical expertise with operational execution, partnering with actuarial, finance and product teams to inform pricing, spend forecasting, and stop-loss considerations across the organization.