Clinical Formulary Pharmacist

Centene Corporation

. Define and develop standard and custom formularies for Commercial, Medicaid, Medicare Part D, and Health Information Marketplace lines of business .

Posted 9/21/2026full-timeRemote • Florida • United StatesMid-LevelSenior💰 $107,700 - $199,300 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in developing formularies and clinical criteria for various pharmacy benefit programs, while ensuring compliance with regulatory requirements. Proficient in analyzing drug utilization trends and providing clinical guidance to pharmacy technicians.

Highest-signal resume keywords

Pharmacy Benefit DesignFormulary DevelopmentClinical Criteria DevelopmentDrug Utilization ReviewPharmacy & Therapeutics Committee Support

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Drug Product ReviewMedication AnalysisPrior Authorization GuidelinesClinical Edits DevelopmentCost of Care AnalysisDrug Information ResearchFormulary RecommendationsMedication-Use Protocols

Soft Skills

Clinical GuidanceCommunication

Certifications & Qualifications

Pharmacist License

Industry Keywords

Managed Care PharmacyMedicaidMedicare Part DHealth Information MarketplaceDrug Utilization Trends

About the role

Key responsibilities & impact

Define and develop standard and custom formularies for Commercial, Medicaid, Medicare Part D, and Health Information Marketplace lines of business
Develop drug product reviews and formulary recommendations by assessing drug use trends, new drug releases, and primary literature
Analyze pharmacy cost of care and trends, and coordinate appropriate-use protocols and guidelines
Set criteria for medication analysis and coordinate client reports
Meet regulatory reporting requirements for drug utilization review and fraud and abuse reporting
Develop clinical criteria for non-formulary or non-preferred drug list medications and communicate recommendations to clients
Develop and design clinical edits to adjudicate claims and enhance drug utilization
Develop and review prior authorization and non-formulary guideline criteria supporting Pharmacy and Therapeutics Committee functions and pharmacy benefit design
Research drug information for prior authorization reviews
Provide clinical guidance and support to assigned pharmacy technicians
Prepare support documentation and communications for Pharmacy & Therapeutics Committee reviews and decisions
Perform other duties as assigned
Comply with all policies and standards

Requirements

What you’ll need

Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future
Bachelor’s degree or advanced degree (PharmD., M.S) in pharmacy
3+ years of combined managed care pharmacy or pharmacy residency program experience
Current state’s Pharmacist license with no restrictions
Knowledge of drug use trends, new drug releases, primary literature, pharmacy cost of care, and drug utilization review
Ability to develop clinical criteria, prior authorization guidelines, formulary recommendations, clinical edits, and medication-use protocols
Ability to research drug information and maintain drug knowledge and disease state understanding
Ability to provide clinical guidance to pharmacy technicians
Ability to support Pharmacy & Therapeutic Committee review processes

Benefits

Comp & perks

Competitive pay
Health insurance
401K plan
Stock purchase plans
Tuition reimbursement
Paid time off plus holidays
Flexible approach to work with remote, hybrid, field or office work schedules
Additional forms of incentives may be included in total compensation
Benefits may be subject to program eligibility