Clinical Manager, Medicare & Formulary Operations
Rightway
full-time
Posted on:
Location Type: Remote
Location: Remote • 🇺🇸 United States
Visit company websiteSalary
💰 $140,000 - $160,000 per year
Job Level
Mid-LevelSenior
About the role
- Support the design, implementation, and maintenance of Rightway’s Medicare and Commercial formularies, including client-specific and standard drug offerings.
- Collaborate with the claims platform team to ensure accurate formulary coding and functionality; support regular formulary testing and validation.
- Oversee formulary operations, ensuring alignment with regulatory standards and audit readiness.
- Serve as a clinical and strategic partner in rebate-related activities—collaborating with rebate aggregators, pharmaceutical manufacturers, and health plans—and provide clinical input into financial modeling and evaluations.
- Apply clinical effectiveness data and analytical tools to inform formulary decisions and strategies.
- Contribute to and support Rightway’s P&T Committee with strategic insights, drug evaluations, and formulary performance updates.
- Partner with Product, D&I, and Marketing to evolve our formulary solutions and bring them to market in ways that enhance the member experience.
- Facilitate communication to and education of clients, members, and internal staff regarding clinical issues and objectives
- Provide support to operational teams and clients during implementation
- Support RFI and RFP submissions, as required
Requirements
- Pharmacist licensed in the state in which you reside.
- 5+ years of pharmacy operations experience working within a health plan or PBM, with 3+ years of Medicare formulary operations experience.
- Moderate to high-level expertise in MS Excel
- Strong background in formulary coding within a PBM platforms
- Strong demonstrable expertise in pharmacy operations, including identifying and eliminating operational inefficiencies.
- Deep understanding of formulary development, implementation, and oversight processes.
- Experience working with rebate aggregators or manufacturers in formulary and rebate strategy.
- Highly analytical, with the ability to use data and clinical insights to guide formulary strategy and decision-making.
- Strong collaborator and communicator, with the ability to work cross-functionally and influence stakeholders.
- Comfortable operating in a fast-paced, evolving environment with a proactive, ownership-oriented mindset.
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
formulary codingpharmacy operationsMedicare formulary operationsdata analysisclinical effectiveness datafinancial modelingformulary developmentformulary implementationMS Excel
Soft skills
collaborationcommunicationanalytical thinkinginfluencing stakeholdersproactive mindsetownership-oriented mindset
Certifications
Pharmacist license