Senior Clinical Pharmacist

This role supports the Federal Employees Program Part D/Employer Group Waiver Program pharmacy benefit in all clinical pharmacy functions including but not limited to formulary development, coverage determination and appeals, prior approval, and utilization process maintenance. Provides clinical and plan-sponsor oversight for the Federal Employees Program Medicare Prescription Drug Program/Employer Group Waiver Plan. The role oversees delegated clinical functions, formulary administration, Centers for Medicare & Medicaid Services reporting, compliance, audit readiness, and coordination with the Pharmacy Benefit Manager and internal stakeholders. - Serves as the clinical subject matter expert for Medicare Part D benefit design, formulary administration, supplemental wrap coverage, utilization management, and coverage determinations. - Oversees delegated Pharmacy Benefit Manager clinical functions, performance, issues, corrective actions, and follow-up activities. Reviews formulary and utilization-management materials, coverage determination and appeals, including prior authorization, step therapy, quantity limits, transition requirements, and formulary changes. - Responsible for reviewing, editing and completing Employer Group Waiver Program Medicare submissions, formulary, Pharmacy and Therapeutics modules, transition supply etc., and review and downloading patient safety and other requires files though the Health Plan Management System portal. - Supports audit readiness, evidence validation, remediation tracking, and clinical quality-control reviews. Reviews Part B versus Part D coverage requirements and supports accurate benefit determinations and member communications. Develops and maintains Medicare PDP oversight policies, procedures, controls, and process documentation - Provides support to internal pharmacy workgroups. Provides clinical guidance for presentations, plan education, executive updates, Office of Personnel Management responses, and cross-functional initiatives. - Participates in Medicare P&T and utilization-management activities and evaluates the impact of clinical and benefit changes. The posting range for this position is: 115,900.00 - 168,025.00 Qualifications: Education Required PharmD Experience Required 5 + Years pharmacy residency or 3-5 years of work experience in the Health Plan or Pharmacy benefit manager environment Knowledge Skills and Abilities Knowledge of Medicare Part D, formulary and utilization-management requirements, delegated oversight, compliance, and audit readiness. Strong clinical judgment, analytical, quality-control, communication, and cross-functional collaboration skills. Excellent interpersonal skills and the ability to work with all levels of the Association, Plans, government agencies and vendors. Communication skills, written and oral. Technical proficiency with information technologies (Microsoft software applications e.g. Excel). Preferred: Demonstrates AI literacy and an understanding of generative AI tools, including appropriate business applications and limitations. Certifications & Licenses Required: PHARMD - Licensed Pharmacist - Various PharmD required and licensed pharmacist to perform clinical duties Extra Posting Information: Experience that is indicative of the ability to understand how health care and patient care is delivered and how health care professionals interact in the health care environment. Experience with drug utilization review and formulary programs. #LI-Hybrid The posted salary range is the lowest to highest salary we, in good faith, believe we would pay for this role at the time of this posting.  We may ultimately pay more or less than the hiring range andthis hiring range may also be modified in the future. A candidate’s position within the hiring range may be based on several factors including, but not limited to, specific competencies, relevant education, qualifications, certifications, relevant experience, skills, seniority, performance, shift, travel requirements, and business or organizational needs.This job is also eligible for annual bonusincentive pay. We offer a comprehensive package of benefits including paid time off, 11 holidays,medical/dental/vision insurance, generous 401(k) matching, lifestyle spending account and many other benefits to eligible employees. Note: No amount of pay is considered to be wages or compensation until such amount is earned, vested, and determinable. The amount and availability of any bonus, commission, or any other form of compensation that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.