At St. Luke’s, we pride ourselves on fostering a workplace culture that values diversity, promotes collaboration, and prioritizes employee well-being. Our commitment to excellence in patient care extends to creating an environment where our team can thrive both personally and professionally. With opportunities for growth, competitive benefits, and a supportive community of colleagues, St. Luke’s is truly a great place to work.
Are you a forward-thinking, clinically driven pharmacist with a passion for shaping the future of managed care? Do you thrive in an environment that requires strategic thinking, innovation, and leadership? If so, we have the perfect opportunity for you!
St. Luke’s Health Plan is seeking a Senior Managed Care Clinical Pharmacist to lead and elevate our Pharmacy Benefits team.
What You Can Expect
Drive Formulary and Drug Strategy: Lead the charge in designing and refining the pharmacy formulary and drug strategies. Use your expertise to analyze new drugs, clinical guidelines, and market trends to recommend evidence-based utilization management strategies that minimize cost and maximize outcomes for our members.
Lead Prior Authorization and Claims Adjudication: Oversee the PA process and claims adjudication, ensuring seamless operations and accurate communication with members. You’ll play a critical role in determining coverage for specialty medications, reviewing appeals, and coordinating with our pharmacy appeals committee and medical directors.
Collaborate Across Teams: Provide expert clinical support and guidance to internal teams, including clinical, medical benefit, customer service, sales, operations, and analytics. Your collaborative approach will help ensure the success of our pharmacy programs and operational goals.
Optimize Drug Positioning & Utilization: Leverage your deep understanding of the market and regulatory landscape to make strategic recommendations for formulary positioning, class reviews, and rebate optimization. Use claims data and trends to proactively mitigate costs and trends.
Monitor and Evaluate New Drugs: Perform detailed cost and clinical analyses of new drugs entering the market. Ensure their appropriate positioning on formularies, minimizing disruption to members while maximizing cost-effectiveness.
Vendor and Stakeholder Engagement: Manage relationships with vendor partners, ensuring smooth coordination on claims adjudication, software design, and member services. Communicate with external stakeholders with professionalism and precision.
Ensure Compliance & Operational Excellence: Monitor day-to-day operations, ensuring adherence to timelines and regulatory compliance. Partner with state agencies to stay aligned with PBM operations, utilization management standards, and accreditation requirements.
Lead Innovative Initiatives: Play a key role in the design and implementation of new insurance products, keeping St. Luke’s Health Plan at the forefront of the managed care landscape.
Qualifications
Preferred Qualifications
Strategic Leadership: Your experience managing formulary strategy and clinical drug reviews positions you as a thought leader in optimizing both health outcomes and costs.
At St. Luke’s, caring for people in the communities we serve is our mission – and this includes our own SLHS team. We offer a robust benefits package to support our teams both professionally and personally. In addition to a competitive salary and retirement plans, we ensure our team feels supported in their benefits beyond the typical medical, dental, and vision offerings. We care about you and have fantastic financial and physical wellness options, such as: on-site massages, on-site counseling via our Employee Assistance Program, access to the Virgin Pulse Wellness tool, as well as other formal training and career development offerings to ensure you are meeting your career goals.
St. Luke’s is an equal opportunity employer and does not discriminate against any person on the basis of race, religion, color, gender, gender identity, sexual orientation, age, national origin, disability, veteran status, or any other status or condition protected by law.
*Please note: this posting is not reflective of all job duties and responsibilities and is intended to provide an overview to job seekers.
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