Director, Formulary and Utilization Management

Job Description

Location: Remote (US-based)

We are seeking a Director, Formulary and Utilization Management to lead formulary strategy, utilization management program design, and specialty pharmacy initiatives within a national managed care environment. This position is a full-time, direct hire opportunity available fully remote within the United States.

This role is best aligned for a pharmacy leader with deep managed care or PBM experience who operates at the enterprise level. You will lead P&T Committee activity, own the prior authorization and step therapy program design, set biosimilar and specialty strategy, and translate clinical evidence into coverage policy that holds up with regulators and finance alike. The ideal candidate has run a formulary at scale and can defend a UM decision to a physician, a compliance officer, and a CFO with equal credibility.

Responsibilities:

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

Qualifications:

• PharmD from an ACPE-accredited institution required; MD or DO considered with equivalent managed care pharmacy leadership experience
• Active, unrestricted pharmacist license required
• Minimum of 5 years of formulary management, PBM, managed care, or pharmacy leadership experience required
• Demonstrated experience leading or serving on a Pharmacy and Therapeutics Committee required
• Strong working knowledge of Medicare Part D, CMS pharmacy requirements, formulary governance, and utilization management strategy required
• Board certification such as BCPS or BCACP preferred
• Knowledge of specialty pharmacy operations, biosimilar management, REMS programs, and value-based formulary strategy preferred
• Ability to evaluate complex clinical evidence and translate findings into operational coverage policy
• Strong leadership, executive communication, and cross-functional influence skills

Schedule:

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

Salary Range:

The salary range for this position is approximately $165,000 – $200,000 annually ($79.33 – $96.15 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 Senior 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.