Strategic Pharmacist: Formulary & PBM Oversight

CommunityCare HMO Inc.; Tulsa (OK); On-site; USD 120,000 - 150,000; Full time

Job summary

CommunityCare HMO Inc. in Tulsa, OK is seeking a Clinical Pharmacist – Formulary & PBM Oversight to lead clinical management of formulary strategy, PBM oversight, and related clinical programs across lines of business.

You will provide oversight of delegated utilization management and support governance of Pharmacy & Therapeutics committees while striving to improve quality, member experience, and cost efficiency.

Qualifications

• Strong knowledge of managed care pharmacy, formulary management, utilization management, and PBM operations.
• Experience with Medicare Part D, Commercial, and Marketplace PBM operations.
• Knowledge of coverage determinations, prior authorizations, appeals, step therapy, quantity limits, and utilization management processes.
• Ability to interpret clinical literature, guidelines, criteria, and regulatory requirements.
• Understanding of PBM clinical functions and health plan oversight responsibilities.
• Strong analytical, organizational, critical thinking, and decision-making skills.
• Ability to translate data into actionable recommendations.
• Excellent written, verbal, presentation, and collaboration skills.
• Proficiency with Microsoft Office and pharmacy information systems.

Responsibilities

• Perform clinical audits of initial and appeal utilization management determinations to evaluate appropriateness and compliance.
• Provide clinical oversight of delegated PBM utilization management and formulary activities.
• Coordinate Pharmacy & Therapeutics Committee activities and formulary decisions.
• Monitor clinical and financial impact of formulary strategies and utilization management programs.
• Provide personalized member counseling related to formulary changes and medication access.
• Develop prescriber notifications and provider outreach for formulary changes.
• Support provider education and academic detailing to optimize formulary use.
• Collaborate on pharmacy cost-management, budgeting, forecasting, and program evaluation.
• Support formulary publication and updates across resources.
• Collaborate with Pharmacy leadership, Medical Directors, Finance, and Compliance.
• Support clinical governance committees and other pharmacy initiatives.
• Perform other job-related duties as required.

Skills

Managed care pharmacy

PBM operations

Formulary management

Utilization management

Pharmacy data analysis

Medicare Part D knowledge

Regulatory knowledge

Communication skills

Microsoft Office

Pharmacy systems

Education

PharmD or B.S. in Pharmacy

Job description

CommunityCare HMO Inc. in Tulsa, OK is seeking a Clinical Pharmacist – Formulary & PBM Oversight to lead clinical management of formulary strategy, PBM oversight, and related clinical programs across lines of business.

You will provide oversight of delegated utilization management and support governance of Pharmacy & Therapeutics committees while striving to improve quality, member experience, and cost efficiency.