Clinical Pharmacist, Pharmacy Benefit Management (PBM)

Job Description

Location: Chicago, IL (Onsite)

We are seeking a Clinical Pharmacist, Pharmacy Benefit Management (PBM) to support formulary strategy, clinical program development, and pharmacy benefit decision-making. This role is responsible for evaluating drug therapies, developing utilization management criteria, supporting prior authorization and appeals processes, and contributing to evidence-based pharmacy policy.

This position is ideal for a PharmD-level pharmacist with managed care or PBM experience who can interpret clinical evidence, analyze utilization trends, and translate findings into practical recommendations that support safe, effective, and cost-conscious medication use.

Responsibilities:

• Conduct clinical drug reviews and therapeutic assessments to support formulary recommendations
• Develop prior authorization criteria for specialty and high-cost medications based on clinical evidence and FDA labeling
• Perform drug utilization reviews to identify adherence trends, inappropriate use, and opportunities for intervention
• Evaluate new medications for formulary placement, step therapy requirements, and quantity limits
• Support development of clinical pharmacy programs focused on adherence, therapeutic substitution, and specialty drug management
• Review prior authorization appeals and coverage exception requests for clinical appropriateness
• Collaborate with medical directors and clinical leadership on pharmacy benefit policy and guideline development
• Support CMS Part D activities, including formulary requirements, exceptions, appeals, and medication therapy management
• Prepare clinical monographs, therapeutic class reviews, and alternative therapy analyses for committee review
• Monitor drug pipeline updates, clinical guidelines, and emerging evidence to inform pharmacy benefit strategy
• Partner with cross-functional teams to support compliant and clinically sound utilization management processes
• Maintain accurate documentation of clinical reviews, recommendations, and policy decisions

Qualifications:

• Doctor of Pharmacy (PharmD) degree from an accredited college of pharmacy required
• Active pharmacist license required; multi-state licensure preferred
• Minimum of 3 years of experience in PBM, managed care pharmacy, or health plan pharmacy operations required
• Strong knowledge of formulary management, drug utilization review, and prior authorization policy development
• Familiarity with CMS Part D requirements, medication therapy management, and specialty pharmacy management
• Experience evaluating clinical evidence and presenting recommendations for formulary or P&T committee review
• Strong analytical, communication, and documentation skills
• Ability to collaborate with medical directors, clinical teams, and pharmacy benefit stakeholders

Schedule:

• Full-time position
• Standard business hours
• Standard full-time hours per pay period

Salary Range: The salary range for this position is approximately $115,000 – $145,000 annually ($55.29 – $69.71 per hour), based on experience and qualifications.

Interview Process:

• Selected candidates will participate in a multi-step interview process, including an initial screening with TalentLNX followed by interviews with department leadership.

Equal Opportunity Employer: TalentLNX is committed to equal employment opportunity and a diverse, inclusive workforce. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status.