Medical Director, Pharmacy

Job Description

Location: Remote (US-based)

We are seeking a Medical Director, Pharmacy to provide strategic clinical leadership across formulary management, pharmacy policy development, utilization management, and specialty pharmacy initiatives within a national managed care environment. This role is responsible for guiding evidence-based pharmacy strategy, supporting regulatory compliance, and partnering with operational and executive leadership teams to improve both clinical and financial outcomes.

This position is ideal for an experienced physician or pharmacy executive with deep managed care or PBM leadership experience who is comfortable operating at an enterprise level while translating complex clinical evidence into actionable pharmacy benefit strategy.

Responsibilities:

• Lead Pharmacy & Therapeutics (P&T) Committee activities including clinical review of new medications, biosimilars, and formulary optimization initiatives
• Develop and oversee evidence-based utilization management programs including prior authorization, step therapy, and formulary controls
• Support specialty pharmacy strategy including biosimilar conversion initiatives, site-of-care optimization, and high-cost medication management
• Serve as a clinical liaison for PBM oversight, formulary governance, and pharmacy benefit strategy discussions
• Lead pharmacy quality initiatives tied to HEDIS, Stars, medication adherence, and chronic disease management programs
• Develop integrated medication management strategies for high-risk and complex member populations
• Review pharmacy appeals, medical necessity determinations, and coverage exception requests
• Monitor emerging drug pipeline activity, FDA approvals, and clinical literature to support proactive formulary planning
• Partner with compliance and regulatory teams to ensure adherence with CMS Part D, Medicaid, and pharmacy benefit requirements
• Support development of clinical monographs, therapeutic reviews, and evidence summaries for executive and committee review
• Collaborate with operational, actuarial, and clinical leadership teams on pharmacy strategy and utilization trends
• Maintain awareness of evolving pharmacy regulations, specialty drug management practices, and industry best practices

Qualifications:

• Active MD, DO, or PharmD license required
• Board certification in Internal Medicine, Family Medicine, Clinical Pharmacology, Preventive Medicine, or related specialty preferred
• Minimum of 5 years of formulary management, PBM, managed care, or pharmacy leadership experience required
• Strong knowledge of Medicare Part D, CMS pharmacy requirements, formulary governance, and utilization management strategies
• Experience leading or participating in Pharmacy & Therapeutics (P&T) Committee activities required
• Knowledge of specialty pharmacy operations, biosimilar management, REMS programs, and value-based formulary strategy preferred
• Strong leadership, executive communication, and clinical decision-making skills
• Ability to evaluate complex clinical evidence and translate findings into operational policy recommendations

Schedule:

• Full-time, remote position
• Monday through Friday standard business hours
• Flexible scheduling within operational needs

Salary Range: The salary range for this position is approximately $195,000 – $240,000 annually ($93.75 – $115.38 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.