Clinical Pharmacy Manager, Formulary Strategy

Job description

Description

Medica is a nonprofit health plan with more than a million members that serves communities in Minnesota, Nebraska, Wisconsin, Missouri, and beyond. We deliver personalized health care experiences and partner closely with providers to ensure members are genuinely cared for.

We're a team that owns our work with accountability, makes data-driven decisions, embraces continuous learning, and celebrates collaboration - because success is a team sport. It's our mission to be there in the moments that matter most for our members and employees. Join us in creating a community of connected care, where coordinated, quality service is the norm and every member feels valued.

The Clinical Pharmacy Manager, Formulary Strategy is responsible for leading the development, maintenance, and oversight of the health plan's enterprise clinical pharmacy positions across all drug classes and lines of business (Individual, Commercial, Medicare, and Medicaid). This role ensures consistent, evidence based clinical decision making through strong governance processes, high quality clinical policy and utilization management (UM) criteria, and effective coordination across internal teams and external stakeholders.

The position serves as a central clinical authority supporting P&T and Formulary Value Committees (FVC), drug pipeline preparedness, therapeutic class strategy, and ongoing modernization of clinical criteria-balancing clinical quality, member access, affordability, and regulatory requirements. Other duties as assigned.

Key Accountabilities

Clinical Position Strategy & Governance Establish and oversee clinical position strategy for all drug classes, including specialty, and emerging therapies

Ensure consistency, transparency, and evidencebased rationale across formulary coverage, UM criteria, and clinical policy decisions

Provide governance oversight for clinical escalations, complex coverage questions, and exception resolution

Coordinate crossfunctional alignment between clinical pharmacy, UM operations, finance, actuarial, and PBM partner

Support governance forums by elevating issues, risks, and recommendations in a structured, decisionready format

P&T/FVC Leadership & Drug Evaluation Lead pipeline assessment and drug readiness activities for new molecular entities, biosimilars, expanded indications, and high impact therapies

Lead the development of presentation materials for P&T Committee and Formulary Value Committee (FVC) meetings, including: Drug evaluations and monographs

Therapeutic class reviews

Comparative effectiveness assessments

Financial and utilization considerations (in partnership with analytics/actuarial/finance)

Develop clear, defensible, evidence based recommendations to support committee decision making

Serve as a subject matter expert during committee discussions and executive escalations

Therapeutic Class Management Lead therapeutic class strategy reviews to ensure clinical positions remain current with evolving standards of care

Evaluate clinical evidence, treatment guidelines, realworld data, and safety considerations

Identify opportunities for clinical optimization, standardization, and alignment across lines of business

Recommend updates to clinical positioning based on new evidence or utilization trends

Utilization Management & Clinical Policy Development

Oversee custom policy writing for pharmacy and medical benefit drugs

Lead development and maintenance of UM clinical criteria, including prior authorization, step therapy, quantity limits, and coverage limitations

Conduct policy gap analyses to identify misalignment, outdated criteria, or regulatory risk

Ensure timely and clinically appropriate criteria updates, including: NF (Non Formulary) drug criteria

Newly approved therapies

Safety driven or guideline driven changes

Ensure policies and criteria are defensible, auditable, and aligned with regulatory and accreditation standards

Oversight, Escalation & Stakeholder Management Manage stakeholder relationships with internal and external partners

Communicate clinical strategy clearly to both clinical and non clinical audiences

Team Development & Resource Coordination Provide direction, mentorship, and clinical oversight for pharmacists and analysts supporting governance, policy, and P&T work

Coordinate workload, prioritization, and resource allocation to ensure timely delivery of clinical deliverables

Support knowledge development, standard work, and process improvement within the clinical governance function

Required Qualifications

Bachelor's degree in Pharmacy or PharmD required

5+ years of related work experience in health plan pharmacy, PBM clinical management, or related clinical leadership role beyond degree

1+ years of leadership experience

Required Certifications/Licensure

Active Pharmacist license required

Preferred Qualifications

Demonstrated experience with: Clinical policy and UM criteria development

P&T Committee support and presentations

Drug evaluations and therapeutic class reviews

Experience working within regulated environments (Medicare and/or Medicaid)

Board certification (e.g., BCPS or other relevant specialty)

Experience in plan-led or hybrid PBM models

Familiarity with accreditation and regulatory frameworks (e.g., CMS, NCQA)

Leadership experience overseeing clinical pharmacists or matrixed teams

Clinical credibility and sound judgment

Strong governance mindset and attention to consistency

Ability to translate evidence into practical, defensible clinical positions

Executive level presentation and communication skills

Collaborative, cross functional leadership

This position is a Remote role.To be eligible for consideration, candidates must have a primary home address located within any state where Medica is registered as an employer - AR, AZ, FL, GA, IA, IL, KS, KY, MI, MN, MO, ND, NE, OK, SD, TN, TX, VA, WI.

The full salary grade for this position is $113,400 - $194,400. While the full salary grade is provided, the typical hiring salary range for this role is expected to be between $113,400 - $170,100. Annual salary range placement will depend on a variety of factors including, but not limited to, education, work experience, applicable certifications and/or licensure, the position's scope and responsibility, internal pay equity and external market salary data. In addition to base compensation, this position may be eligible for incentive plan compensation in addition to base salary. Medica offers a generous total rewards package that includes competitive medical, dental, vision, PTO, Holidays, paid volunteer time off, 401K contributions, caregiver services and many other benefits to support our employees.

The compensation and benefits information is provided as of the date of this posting. Medica's compensation and benefits are subject to change at any time, with or without notice, subject to applicable law.

Eligibility to work in the US: Medica does not offer work visa sponsorship for this role. All candidates must be legally authorized to work in the United States at the time of application. Employment is contingent on verification of identity and eligibility to work in the United States.

We are an Equal Opportunity employer, where all qualified candidates receive consideration for employment indiscriminate of race, religion, ethnicity, national origin, citizenship, gender, gender identity, sexual orientation, age, veteran status, disability, genetic information, or any other protected characteristic.

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities

This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.

Who can apply

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