Strategic Pharmacist: Formulary & UM Lead

Highmark Health; Dover (DE); Hybrid; USD 118,000 - 197,000; Full time

Job summary

Highmark Inc. is seeking a senior pharmacy strategy professional to oversee formulary development, utilization management, and compliance across our prescription drug benefit programs.

The role requires collaboration with analytics teams and external partners to advance clinical initiatives. You will lead educational initiatives for physicians and members, guide junior staff, and manage projects to improve efficiency while ensuring adherence to federal and state mandates within a hybrid work

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, progressive experience in the pharmacy area of specialization
• Bachelor of Science in Pharmacy or Doctor of Pharmacy degree required
• Registered Pharmacist (Non-State Specific) required
• Board Certification in Pharmacotherapy or Geriatric Pharmacist preferred

Responsibilities

• Lead formulary and utilization management strategy and development
• Develop and monitor pharmacy programs such as prior authorization, dose/duration edits, quantity limits, step therapy, and policy reviews
• Ensure regulatory compliance for prescription drug benefits, formulary, and UM policies
• Collaborate with internal analytics and external vendors to generate real-world evidence for pharmacy strategy
• Provide guidance and mentorship to junior team members
• Communicate education initiatives to physicians, clients, and members
• Manage department projects and process improvements
• Interact with manufacturers, PBMs, and strategic partners as needed

Skills

Managed care

Verbal & written communication

Microsoft Office

Data processing

Problem solving

Education

Bachelor of Science in Pharmacy

Doctor of Pharmacy

Board Certified Pharmacotherapy Specialist

Board Certified Geriatric Pharmacist

Tools

Database applications

Job description

Highmark Inc. is seeking a senior pharmacy strategy professional to oversee formulary development, utilization management, and compliance across our prescription drug benefit programs.

The role requires collaboration with analytics teams and external partners to advance clinical initiatives. You will lead educational initiatives for physicians and members, guide junior staff, and manage projects to improve efficiency while ensuring adherence to federal and state mandates within a hybrid work