Senior Manager, Pharmacy

About the role

We’re seeking a strategic, hands-on pharmacy leader to own clinical oversight of our PBM and pharmacy vendors, drive formulary and UM strategy, and provide clinical expertise to shape our pharmacy affordability programs. This role bridges clinical expertise and operational execution to drive sustainable pharmacy spend and strong member outcomes.

Responsibilities

• Serve as the primary pharmacy clinical lead for our PBM partnership, including oversight of utilization management, formulary and clinical programs
• Design, implement and manage clinical programs that drive affordability, quality, and member outcomes
• Provide clinical oversight of pharmacy vendors and clinical programs that improve outcomes and reduce unnecessary utilization
• Own formulary design and maintenance, including tier strategy, drug placement, therapeutic class management, and clinical edit logic
• Complete reviews of prior authorization decisions and appeals for specialty and non-specialty drugs
• Develop and maintain policies related to clinical pharmacy and both pharmacy and medical benefit drugs
• Collaborate with actuarial, finance, and product teams to inform pricing, trend modeling, pharmacy spend forecasting, and stop-loss considerations
• Partner cross-functionally with product, clinical, network, actuarial and other stakeholders to ensure integrated care approaches
• Ensure compliance with applicable regulatory, accreditation, and clinical governance standards, maintaining high ethical and quality standards

Requirements

• PharmD degree and active, unrestricted pharmacist license required
• 5+ years of pharmacy experience in clinical operations, utilization management, or formulary leadership
• Demonstrated experience in contracting oversight or performance evaluation with PBMs or pharmacy vendors

Qualifications

• (Bonus) Experience working within commercial level-funded health plans and/or innovative health insurers (e.g., startup or growth-stage plans)

About Gravie

• We know healthcare. Our company was founded and is still led by industry veterans who have started and grown several market-leading companies in the space.
• We have raised money from top tier investors who share the same long-term vision as we do of building an industry defining company that will endure over the long run. We are well capitalized.
• Our clients love us. Customer satisfaction rates among employees using Gravie health plans consistently rank above 80% – nearly 40 points above the industry average.
• Our culture is unique. We tend to be non-hierarchical, merit-driven, opinionated but kind people who thrive working in a high-performance, fast-paced environment. People at Gravie care deeply about making a positive impact in the lives of the people we serve.

Benefits

• Standard health and wellness benefits
• Alternative medicine coverage
• Flexible PTO
• Up to 16 weeks paid parental leave
• Paid holidays
• 401k program
• Transportation perks
• Education reimbursement
• 2 days of paid paw-ternity leave

Pay

Compensation Range: $151.5K - $202K