Clinical, Formulary Management Pharmacist

About this role

ABOUT THE ROLE:

We are seeking a Pharmacist, Formulary & Clinical Strategy to join Rightway's growing Clinical Strategy team. This is an early-career role designed for a clinical pharmacist who is ready to apply their managed care expertise in a technology-forward, fast-paced environment.

You will support the design, maintenance, and optimization of Rightway's formularies and prior authorization (PA) criteria, while also contributing to data-informed recommendations that shape our clinical strategy. Critically, this role is for someone who is not just comfortable with AI tools — but actively uses them to work smarter, move faster, and surface better insights.

This role reports to the leader of Clinical Strategy and works cross-functionally with Product, Data & Insights, Cost of Goods, and Client Operations.

WHAT YOU’LL DO:

Data Interpretation & Clinical Recommendations

• Interpret formulary and clinical program performance data — using available dashboards and reporting tools — to identify trends and opportunities.

• Translate data findings into clear, actionable clinical recommendations for clinical strategy leadership

• Support RFI and RFP submissions with data-driven clinical insights.

AI-Enabled Workflows

• Actively incorporate AI tools into your daily workflow — from literature review and PA criteria drafting to formulary documentation and data summarization.

• Identify opportunities where AI can streamline clinical operations tasks and help the team scale effectively.

• Contribute to Rightway's evolving approach to AI adoption in clinical work; share learnings and best practices with the broader team.

• Leverage AI-assisted tools to synthesize clinical literature, draft policy language, and accelerate research tasks.

Formulary Development/Strategy

• Support the development, maintenance, and updating of Rightway formularies, including standard and custom drug lists.

• Assist in formulary coding and collaborate with the claims platform team to ensure accuracy and functionality.

• Participate in formulary testing, validation, and ongoing quality review.

• Contribute to Pharmacy & Therapeutics (P&T) Committee meetings with drug evaluations, literature summaries, and formulary performance updates.

• Help explore and support the implementation of non-traditional formulary designs beyond tier-based structures.

Prior Authorization & Clinical Policy

• Develop, maintain, and update prior authorization criteria and clinical coverage policies.

• Review PA criteria against current clinical evidence, payer benchmarks, and regulatory standards.

• Support clinical reviews and provide recommendations on complex or escalated PA cases, as needed.

• Assist in communicating PA criteria changes to operational teams, clients, and members.

• Partner with Director of Utilization Management on the implementation and operations of clinical strategy

Cross-Functional Collaboration & Client Support

• Partner with Product, Data & Insights, Cost of Goods, and Client Operations teams to support formulary and clinical program implementation.

• Provide clinical support to operational teams and clients during implementation and ongoing account management.

• Facilitate communication and education to clients, members, and internal staff on clinical topics and formulary changes.

WHO YOU ARE:

• PharmD required; active pharmacist licensure in at least one US state.

• 1–3 years of experience in managed care pharmacy, health plan, or PBM — OR successful completion of a managed care or health-system PGY1/PGY2 residency.

• Proficient with AI tools in a professional context — you regularly use tools like ChatGPT, Claude, Copilot, or similar to accelerate and improve your work.

• Working knowledge of formulary management, PA criteria development, and managed care fundamentals.

• Comfortable reading and interpreting data (e.g., dashboards, utilization reports) and translating findings into clinical recommendations.

• Strong written and verbal communication skills; able to distill complex clinical topics for non-clinical audiences.

• Organized, detail-oriented, and capable of managing multiple projects simultaneously.

EXTRA CREDIT:

• Experience with PBM platform formulary coding or claims adjudication workflows.

• Familiarity with CMS formulary compliance requirements or Medicare Part D operations.

• Experience using AI tools for clinical literature review, policy drafting, or documentation workflows.

• Comfort working in a fast-paced, startup environment where processes are still being built.

COMPENSATION: $120,000 - $130,000 annually, in addition to bonus and equity

Compensation offered will be determined by geographic location, experience, and qualifications.