Pharmacy Strategy Lead: Formulary & UM

Highmark Health; Phoenix (AZ); Hybrid; USD 118,000 - 197,000; Full time

Job summary

Highmark Inc. is seeking a Pharmacist with extensive experience in managed care to lead formulary and utilization management strategies.

You will work in a hybrid model within 50 miles of the corporate office, coordinating with analytics, external vendors, and cross-functional teams to optimize pharmacy programs and compliance. The role requires strong communication, policy development skills, and experience in implementing prior authorization, step therapy, and other utilization management

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
• Pharmacy licensure (Registered Pharmacist) and Board Certifications preferred

Responsibilities

• Lead formulary and utilization management strategy development to support program savings goals
• Ensure regulatory compliance and oversee formulary administration across state and federal requirements
• Collaborate with analytics and external vendors to generate real-world evidence for policy decisions
• Review and update pharmacy policies, including prior authorization and step therapy rules
• Provide guidance and mentorship to junior team members and cross-functional partners

Skills

Managed care principles

Verbal & written communication

MS Office & databases

Prioritization

Mentorship

Cross-functional collaboration

Education

Pharmacy degree (PharmD or BS in Pharmacy)

Job description

Highmark Inc. is seeking a Pharmacist with extensive experience in managed care to lead formulary and utilization management strategies.

You will work in a hybrid model within 50 miles of the corporate office, coordinating with analytics, external vendors, and cross-functional teams to optimize pharmacy programs and compliance. The role requires strong communication, policy development skills, and experience in implementing prior authorization, step therapy, and other utilization management