Clinical Pharmacist – PBM

Capital Blue Cross

Clinical Pharmacist managing formulary, PBM oversight, and utilization programs for Capital Blue Cross health plans. Supporting quality, compliance, education, and pharmacy benefit strategy.

Posted 8/20/2026full-timeHarrisburg • Pennsylvania • 🇺🇸 United StatesMid-LevelSenior💰 $98,880 - $186,290 per yearWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in developing and managing pharmacy clinical initiatives, drug formulary programs, and utilization management while ensuring compliance with Medicare Part D and regulatory standards. Possesses strong clinical and analytical skills to assess utilization data and improve quality of care.

Highest-signal resume keywords

Pharmacy DegreeCurrent Pennsylvania Pharmacy LicensePharmacy Clinical Protocol DevelopmentDrug Formulary ManagementMedicare Part D Compliance

ATS Keywords

Tailor your resume

Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills

Pharmacy Clinical InitiativesUtilization Management ProgramsDrug Evaluation ProcessesPharmacy Claims ProcessingTherapy Medication ManagementData IntegrationClinical ProtocolsCost Reduction ProgramsQuality of Care ImprovementDecision-Making Capabilities

Soft Skills

Interpersonal SkillsTeamworkCommunication SkillsPresentation SkillsLeadership

Tools & Technologies

Pharmacy Benefit Management SystemsPharmacy and Therapeutics Committee ToolsUtilization Data Assessment Tools

Certifications & Qualifications

Pharmacy DegreeCurrent Pennsylvania Pharmacy LicenseAdvanced Pharmacy Degree (Preferred)

Industry Keywords

Medicare Part DNCQA AccreditationOutpatient Drug BenefitsManaged CareRegulatory Compliance

About the role

Key responsibilities & impact

Develop, maintain, and evaluate pharmacy clinical initiatives and utilization management programs
Manage the drug formulary program, including drug evaluation and Pharmacy and Therapeutics Committee activities
Oversee clinical program administration by the pharmacy benefit management company
Manage pharmaceutical utilization and trends through pharmacy clinical initiatives
Oversee PBM vendor clinical services and programs
Manage specialty pharmaceuticals
Develop pharmacy clinical and utilization management criteria, protocols, policies, and procedures
Provide clinical and drug information support
Maintain Medicare Part D, regulatory, and accreditation compliance
Develop member and provider educational programs
Conduct presentations and training
Maintain provider and pharmaceutical industry/drug manufacturer relations
Provide clinical support to Pharmacy and Therapeutics, Medical Policy, Quality Management, Delegation Oversight, and HEDIS/NCQA committees and workgroups
Supervise staff
Perform other related duties and assignments as directed
Travel less than 1%, including occasional overnight travel and travel between Capital Blue Cross locations

Requirements

What you’ll need

Pharmacy degree required
Current Pennsylvania pharmacy license required
Experience developing pharmacy clinical protocols, policies, and procedures
Experience designing and deploying programs to increase quality of care and decrease costs
In-depth knowledge of drug formulary systems and drug evaluation processes
Broad knowledge of outpatient drug benefits and utilization management programs
Knowledge of pharmacy claims processing and applicable state/federal laws
Knowledge and experience with therapy medication and disease state management
Working knowledge of medical and pharmacy data integration
Strong clinical/analytical skills and decision-making capabilities
Strong interpersonal, teamwork, and communication skills
Ability to lead meetings and deliver verbal presentations
Ability to work with minimal supervision
Ability to assess utilization data
Advanced pharmacy degree (Master's or Pharm.D.) preferred
Managed care knowledge and experience preferred
Medicare Part D and NCQA accreditation knowledge and experience preferred

Benefits

Comp & perks

Medical coverage
Dental coverage
Vision coverage
Retirement Plan
Paid Time Off
Holidays
Volunteer time off
Incentive Plan
Tuition Reimbursement
Flexible environment
Training and continuing education
Community volunteering opportunities