Location: 100% onsite in Huntington Beach, CA. This role requires working in the office five days per week.
Description: Impresiv Health is seeking an experienced Health Plan Pharmacist to support a leading health plan in developing and executing strategic pharmacy initiatives that improve clinical quality, optimize pharmacy spend, and enhance member outcomes. This role serves as a key clinical and strategic partner responsible for formulary management, PBM collaboration, utilization management, pharmacy analytics, and provider engagement. The ideal candidate has deep managed care or Medicare Advantage experience and is passionate about driving innovative, evidence-based pharmacy programs that balance quality care with financial stewardship.
What You Will Do: - Develop and execute formulary strategies that balance clinical effectiveness, member access, and cost containment while maintaining a competitive pharmacy benefit.
- Partner with Pharmacy Benefit Managers (PBMs) to optimize pharmacy benefit performance, challenge recommendations when appropriate, and ensure cost-effective formulary and utilization management strategies.
- Build and maintain strong relationships within the PBM ecosystem to evaluate alternative vendors, pricing strategies, rebate opportunities, and contracting options.
- Lead initiatives to reduce high-frequency and high-cost drug utilization through clinically appropriate, financially responsible pharmacy programs.
- Analyze pharmacy utilization, trend, and financial data to identify opportunities for improved clinical outcomes and cost savings.
- Deliver meaningful analytics, dashboards, and actionable reporting that not only identify issues but also recommend practical solutions and measurable interventions.
- Design and implement provider and member engagement strategies that influence prescribing behaviors through innovative, incentive-based programs that are clinically effective and operationally feasible.
- Support formulary management, utilization management, prior authorization, appeals, and medication policy development.
- Participate in Pharmacy & Therapeutics (P&T) Committee activities, formulary reviews, and clinical policy development.
- Collaborate with Medical Directors, Care Management, Quality, Finance, Provider Relations, Compliance, and Executive Leadership on pharmacy initiatives.
- Monitor specialty pharmacy trends, biosimilars, value-based pharmacy strategies, and emerging industry best practices.
- Ensure compliance with CMS, Medicare Part D, Medicaid, NCQA, state, and federal regulatory requirements.
- Serve as a trusted clinical resource for internal stakeholders, providers, and pharmacy partners.
You Will Be Successful If: - You have strong managed care pharmacy experience and understand the operational and financial drivers of a health plan.
- You are comfortable challenging PBM partners and using data to influence pharmacy strategy and business decisions.
- You can identify opportunities to improve formulary performance while balancing member access, clinical quality, and cost.
- You are skilled at translating complex pharmacy data into actionable recommendations and measurable results.
- You have experience implementing programs that reduce unnecessary pharmacy spend without compromising quality of care.
- You excel at collaborating with cross-functional teams and building relationships with internal and external stakeholders.
- You stay current on pharmacy trends, regulatory changes, and innovative approaches to pharmacy benefit management.
What You Will Bring: - Doctor of Pharmacy (PharmD) required.
- Active pharmacist license in good standing.
- 5+ years of managed care, health plan, PBM, or Medicare Advantage pharmacy experience.
- Strong knowledge of Medicare Part D, Medicaid, commercial pharmacy benefits, and managed care pharmacy operations.
- Experience with formulary management, utilization management, prior authorization, and pharmacy benefit design.
- Experience working directly with PBMs, including formulary strategy, contracting, pricing models, rebate programs, or vendor management.
- Demonstrated experience analyzing pharmacy utilization, financial performance, and clinical outcomes to develop strategic recommendations.
- Experience creating pharmacy reports, dashboards, and analytics that support executive decision-making.
- Strong understanding of specialty pharmacy, high-cost drug management, and utilization management strategies.
- Excellent communication, presentation, negotiation, and stakeholder management skills.
- Experience participating in Pharmacy & Therapeutics (P&T) Committees is preferred.
- Board Certification (BCPS) and Medicare Advantage experience are preferred.
