Clinical Pharmacist IV

Description

Medica is a nonprofit health plan with more than a million members that serves communities in Minnesota, Nebraska, Wisconsin, Missouri, and beyond. We deliver personalized health care experiences and partner closely with providers to ensure members are genuinely cared for.

We're a team that owns our work with accountability, makes data-driven decisions, embraces continuous learning, and celebrates collaboration - because success is a team sport. It's our mission to be there in the moments that matter most for our members and employees. Join us in creating a community of connected care, where coordinated, quality service is the norm and every member feels valued.

The Clinical Pharmacist works collaboratively with internal and external stakeholders to advance pharmacy strategy, utilization management, clinical programs, regulatory requirements, and pharmacy performance. This role applies clinical expertise and data analysis to identify opportunities, evaluate pharmacy spend and trend drivers, develop mitigation strategies, and support initiatives that improve clinical and financial outcomes. The role also partners with PBMs on formulary execution and serves as a clinical pharmacy subject matter expert across a matrixed organization.

Performs other duties as assigned.

• Monitor pharmacy utilization, spend, and trend performance; identify key cost drivers, emerging patterns, and areas of opportunity across the pharmacy benefit.
• Partner with Analytics and business stakeholders to conduct pharmacy spend and trend analysis, including forecasting, utilization impact assessment, variance analysis, and development of actionable insights.
• Develop and support evidence-based strategies to mitigate adverse pharmacy trends and improve clinical and financial performance, including targeted clinical program and utilization management opportunities.
• Serve as a clinical pharmacy subject matter expert and advisor to internal partners; translate complex pharmacy information and data into clear recommendations for decision makers.
• Oversee and coordinate pharmacy-related operational, regulatory, and compliance activities, including required reporting, submissions, audits, transparency requests, and documentation.
• Collaborate with pharmacy vendors, PBM partners, provider organizations, and other external stakeholders to support effective pharmacy program operations and performance.
• Partner closely with PBM partners on formulary execution, including implementation and maintenance of formulary changes, operational alignment, issue resolution, and ongoing monitoring to ensure intended formulary strategy is accurately executed.
• Identify and communicate targeted performance improvement opportunities across the organization and support implementation through cross-functional collaboration.
• Respond to member, provider, client, and internal stakeholder questions or issues related to pharmacy services in a professional and timely manner.
• Participate in clinical pharmacy meetings, work groups, and cross-functional initiatives necessary to advance strategic, operational, and performance objectives.

• Bachelor's degree in Pharmacy required;
  PharmD preferred or equivalent experience in related field.
• 7+ years of related pharmacy experience beyond degree

• Active Pharmacist license required

• Experience in pharmacy operations, clinical programs, utilization management, analytics, regulatory affairs, or related health plan/PBM functions preferred.
• Strong knowledge of pharmacy benefit management, formulary execution, clinical pharmacy programs, pharmacy utilization, and the factors that influence pharmacy spend and trend.
• Ability to interpret pharmacy reporting and translate data into meaningful business and clinical insights; proficiency with reporting and data-analysis tools.
• Ability to analyze pharmacy spend, utilization, and trend drivers and develop practical mitigation recommendations.
• Knowledge of applicable regulatory and compliance requirements affecting pharmacy services.
• Strong written, verbal, presentation, and stakeholder communication skills.
• Effective collaborator in matrixed, multi-disciplinary environment with the ability to influence without direct authority.
• High organized; able to manage multiple projects and priorities while maintaining attention to detail.
• Self-starter who works effectively through ambiguity and changing business or regulatory…