Clinical, Formulary Management Pharmacist

ABOUT THE ROLE:

We are seeking a Pharmacist, Formulary & Clinical Strategy to join Rightway's growing Clinical Strategy team. This is an early-career role designed for a clinical pharmacist who is ready to apply their managed care expertise in a technology-forward, fast-paced environment.

You will support the design, maintenance, and optimization of Rightway's formularies and prior authorization (PA) criteria, while also contributing to data-informed recommendations that shape our clinical strategy. Critically, this role is for someone who is not just comfortable with AI tools — but actively uses them to work smarter, move faster, and surface better insights.

This role reports to the leader of Clinical Strategy and works cross-functionally with Product, Data & Insights, Cost of Goods, and Client Operations.

WHAT YOU’LL DO:

Data Interpretation & Clinical Recommendations

• Interpret formulary and clinical program performance data — using available dashboards and reporting tools — to identify trends and opportunities.
• Translate data findings into clear, actionable clinical recommendations for clinical strategy leadership
• Support RFI and RFP submissions with data-driven clinical insights.

AI-Enabled Workflows

• Actively incorporate AI tools into your daily workflow — from literature review and PA criteria drafting to formulary documentation and data summarization.
• Identify opportunities where AI can streamline clinical operations tasks and help the team scale effectively.
• Contribute to Rightway's evolving approach to AI adoption in clinical work; share learnings and best practices with the broader team.
• Leverage AI-assisted tools to synthesize clinical literature, draft policy language, and accelerate research tasks.

Formulary Development/Strategy

• Support the development, maintenance, and updating of Rightway formularies, including standard and custom drug lists.
• Assist in formulary coding and collaborate with the claims platform team to ensure accuracy and functionality.
• Participate in formulary testing, validation, and ongoing quality review.
• Contribute to Pharmacy & Therapeutics (P&T) Committee meetings with drug evaluations, literature summaries, and formulary performance updates.
• Help explore and support the implementation of non-traditional formulary designs beyond tier-based structures.

Prior Authorization & Clinical Policy

• Develop, maintain, and update prior authorization criteria and clinical coverage policies.
• Review PA criteria against current clinical evidence, payer benchmarks, and regulatory standards.
• Support clinical reviews and provide recommendations on complex or escalated PA cases, as needed.
• Assist in communicating PA criteria changes to operational teams, clients, and members.
• Partner with Director of Utilization Management on the implementation and operations of clinical strategy

Cross-Functional Collaboration & Client Support

• Partner with Product, Data & Insights, Cost of Goods, and Client Operations teams to support formulary and clinical program implementation.
• Provide clinical support to operational teams and clients during implementation and ongoing account management.
• Facilitate communication and education to clients, members, and internal staff on clinical topics and formulary changes.

WHO YOU ARE:

• PharmD required; active pharmacist licensure in at least one US state.
• 1–3 years of experience in managed care pharmacy, health plan, or PBM — OR successful completion of a managed care or health-system PGY1/PGY2 residency.
• Proficient with AI tools in a professional context — you regularly use tools like ChatGPT, Claude, or similar to enhance your work.