Remote Clinical Pharmacist: Medical Policy & Utilization

CommunityCare; Tulsa (OK); Hybrid; USD 110,000 - 170,000; Full time

Job summary

CommunityCare seeks a Clinical Pharmacist – Medical Drug Policy & Oversight to lead evidence-based drug policies, monitor new therapies, and coordinate criteria with PBM. This role ensures aligned medical and pharmacy benefits while guiding utilization management and vendor oversight.

The pharmacist will support clinical governance, provider education, and data-driven program improvements across the organization.

Qualifications

• Doctor of Pharmacy (PharmD) or BS in Pharmacy from an accredited School.
• Active, unrestricted pharmacist license in any United States jurisdiction.
• Minimum of five years of clinical pharmacy experience in managed care pharmacy, health plan pharmacy, PBM, or related setting.
• Experience with oncology medications, biologics, and specialty drug utilization preferred.
• Strong analytical, organizational, critical thinking, and decision-making skills.

Responsibilities

• Lead the development, implementation, maintenance, and annual review of evidence-based medical drug policies and clinical criteria.
• Coordinate medical drug criteria and formulary strategies with PBM to align medical and pharmacy benefits.
• Monitor new drug approvals, indications, biosimilars, oncology therapies, and emerging treatments; evaluate ROI and utilization strategies.
• Monitor Utilization Management pharmacists' decisions and provide clinical education to promote consistency and quality.
• Serve as a clinical resource for complex policy interpretation and coverage criteria.
• Provide clinical oversight of delegated vendors performing oncology and specialty reviews and ensure adherence to criteria.
• Evaluate utilization trends and regulatory changes to improve medical drug utilization management programs.
• Translate new policies into operational workflows and system configurations.
• Support provider education and academic detailing to optimize therapy and reduce costs.

Skills

Managed care pharmacy

Drug utilization management

Formulary management

Analytical thinking

Communication skills

Remote work

Education

PharmD or BS in Pharmacy

Active pharmacist license

5+ years clinical pharmacy experience

Oncology medications experience

Vendor oversight / data analysis

Job description

CommunityCare seeks a Clinical Pharmacist – Medical Drug Policy & Oversight to lead evidence-based drug policies, monitor new therapies, and coordinate criteria with PBM. This role ensures aligned medical and pharmacy benefits while guiding utilization management and vendor oversight.

The pharmacist will support clinical governance, provider education, and data-driven program improvements across the organization.