Clinical Formulary Management Pharmacist

Prime Therapeutics

. Manage formularies and clinical criteria for claims adjudication, prescription drug lists, websites, and related publications .

Posted 11/10/2026full-timeRemote • United StatesJunior💰 $108,000 - $184,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in formulary management, drug review processes, and clinical criteria implementation, while effectively communicating with diverse stakeholders. Proficient in analyzing pharmacy data and managing projects to ensure compliance with regulatory standards.

Highest-signal resume keywords

PharmD Or Bachelor Of Science Pharmacy DegreeCurrent Pharmacist LicenseFormulary Management TechniquesProject Management SkillsPharmacy Data Analysis

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Formulary AdjudicationClinical Criteria ImplementationPrescription Drug List PublishingDrug Review CommitteesUtilization ManagementAnalytical SkillsAttention To DetailOrganizational SkillsResearch SkillsProblem-Solving Skills

Soft Skills

Excellent Written CommunicationExcellent Verbal CommunicationCollaboration SkillsPrioritization SkillsAbility To Work Independently

Tools & Technologies

Microsoft Office SuiteMicrosoft WordMicrosoft ExcelMicrosoft PowerPointMicrosoft VisioMicrosoft Access

Certifications & Qualifications

Pharmacist License

Industry Keywords

Prescription DrugsTherapeutic ClassesHealthcare Industry TrendsHealth PlanPBMManaged MedicaidFormulary OperationsDrug Class ReviewsClaims AdjudicationRegulatory Compliance

About the role

Key responsibilities & impact

Manage formularies and clinical criteria for claims adjudication, prescription drug lists, websites, and related publications
Participate in clinical and financial drug review committees
Perform drug and drug-class reviews and develop formulary placement and utilization management recommendations
Research and explain clinical and business considerations related to drugs, drug classes, and formulary strategies
Provide subject matter expertise to resolve formulary issues
Monitor weekly drug files for new products and apply appropriate drug statuses and formulary placement
Perform routine formulary quality reviews using reports and pharmacy data to identify and resolve discrepancies
Develop and coordinate communications for members, clients, prescribers, pharmacies, and internal stakeholders regarding formulary changes
Serve as liaison among clinical, operational, technical, client, and publishing teams
Maintain committee documentation and action items
Develop team procedures, checklists, and operational best practices
Perform other duties as assigned

Requirements

What you’ll need

PharmD or Bachelor of Science Pharmacy degree
1 year of pharmacy experience in a retail, mail order, health plan, PBM, or similar setting as a pharmacist
Current Pharmacist license to practice in the applicable state(s)
Must be eligible to work in the United States without the need for work visa or residency sponsorship
Knowledge of prescription drugs, disease states, therapeutic classes, formulary management techniques, prescription benefit designs, and current healthcare industry trends
Strong project management, prioritization, and organizational skills
Ability to meet short turnaround times and manage deadline-driven work with minimal oversight
Excellent written and verbal communication skills
Strong analytical and problem-solving skills with attention to detail and quality
Ability to work collaboratively across teams while independently managing day-to-day responsibilities
Ability to quickly learn computer systems and software
Proficiency in Microsoft Office Suite, including Word, Excel, and PowerPoint
Experience with health plan, PBM, Managed Medicaid, formulary operations, drug review committees, or utilization management (preferred)
Experience with formulary adjudication, clinical criteria implementation, prescription drug list publishing, or pharmacy data analysis (preferred)
Experience with Microsoft Visio or Access (preferred)
Must understand, comply with, and attest to job-specific security responsibilities and controls
Must comply with applicable legal, regulatory, contractual requirements, and internal policies and procedures

Benefits

Comp & perks

Benefits, incentives and additional compensation (details available on the Benefits Page)
Equal opportunity and affirmative action employer
Reasonable accommodations for qualified applicants with disabilities
Tobacco-Free Workplace