Clinical, Formulary Management Pharmacist

About the role

We are seeking a Pharmacist, Formulary & Clinical Strategy to join Rightway's growing Clinical Strategy team. This is an early-career role designed for a clinical pharmacist who is ready to apply their managed care expertise in a technology-forward, fast-paced environment. You will support the design, maintenance, and optimization of Rightway's formularies and prior authorization (PA) criteria, while also contributing to data-informed recommendations that shape our clinical strategy. Critically, this role is for someone who is not just comfortable with AI tools - but actively uses them to work smarter, move faster, and surface better insights. This role reports to the leader of Clinical Strategy and works cross-functionally with Product, Data & Insights, Cost of Goods, and Client Operations.

Responsibilities

• Data Interpretation & Clinical Recommendations
• Interpret formulary and clinical program performance data - using available dashboards and reporting tools - to identify trends and opportunities.
• Translate data findings into clear, actionable clinical recommendations for clinical strategy leadership
• Support RFI and RFP submissions with data-driven clinical insights.
• AI-Enabled Workflows
• Actively incorporate AI tools into your daily workflow - from literature review and PA criteria drafting to formulary documentation and data summarization.
• Identify opportunities where AI can streamline clinical operations tasks and help the team scale effectively.
• Contribute to Rightway's evolving approach to AI adoption in clinical work; share learnings and best practices with the broader team.
• Leverage AI-assisted tools to synthesize clinical literature, draft policy language, and accelerate research tasks.
• Formulary Development/Strategy
• Support the development, maintenance, and updating of Rightway formularies, including standard and custom drug lists.
• Assist in formulary coding and collaborate with the claims platform team to ensure accuracy and functionality.
• Participate in formulary testing, validation, and ongoing quality review.
• Contribute to Pharmacy & Therapeutics (P&T) Committee meetings with drug evaluations, literature summaries, and formulary performance updates.
• Help explore and support the implementation of non-traditional formulary designs beyond tier-based structures.
• Prior Authorization & Clinical Policy
• Develop, maintain, and update prior authorization criteria and clinical coverage policies.
• Review PA criteria against current clinical evidence, payer benchmarks, and regulatory standards.
• Support clinical reviews and provide recommendations on complex or escalated PA cases, as needed.
• Assist in communicating PA criteria changes to operational teams, clients, and members.
• Partner with Director of Utilization Management on the implementation and operations of clinical strategy
• Cross-Functional Collaboration & Client Support
• Partner with Product, Data & Insights, Cost of Goods, and Client Operations teams to support formulary and clinical program implementation.
• Provide clinical support to operational teams and clients during implementation and ongoing account management.
• Facilitate communication and education to clients, members, and internal staff on clinical topics and formulary changes.

Requirements

• PharmD required; active pharmacist licensure in at least one US state.
• 1-3 years of experience in managed care pharmacy, health plan, or PBM - OR successful completion of a managed care or health-system PGY1/PGY2 residency.
• Proficient with AI tools in a professional context - you regularly use tools like ChatGPT, Claude, Copilot, or similar to accelerate and improve your work.
• Working knowledge of formulary management, PA criteria development, and managed care fundamentals.
• Comfortable reading and interpreting data (e.g., dashboards, utilization reports) and translating findings into clinical recommendations.
• Strong written and verbal communication skills; able to distill complex clinical topics for non-clinical audiences.
• Organized, detail-oriented, and capable of managing multiple projects simultaneously.
• EXTRA CREDIT:
• Experience with PBM platform formulary coding or claims adjudication workflows.
• Familiarity with CMS formulary compliance requirements or Medicare Part D operations.
• Experience using AI tools for clinical literature review, policy drafting, or documentation workflows.
• Comfort working in a fast-paced, startup environment where processes are still being built.
• COMPENSATION: $120,000 - $130,000 annually, in addition to bonus and equity
• Compensation offered will be determined by geographic location, experience, and qualifications.
• CYBERSECURITY AWARENESS NOTICE
• In response to ongoing and industry-wide fraudulent recruitment activities (i.e., job scams), Rightway wants to inform potential candidates that we will only contact them from the @ rightwayhealthcare.com email domain. We will never ask for bank details or deposits of any kind

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