Clinical Pharmacist

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, Medical Pharmacy is a member of the clinical pharmacy team. The incumbent has responsibility and accountability for overseeing the medical pharmacy clinical strategy for all business segments including IFB, Commercial, Medicaid and Medicare. Key accountabilities include, but are not limited to, leading medical pharmacy policy development and utilization management for all segments, new medical drug clinical assessment and management strategy; and oversight for both internal and delegated medical pharmacy management services. This will include navigating cross-functional processes and systems both within and external to the organization. The position will present medical pharmacy trend and opportunities to key strategic clients. This position works closely with the Manager, Clinical Pharmacy to ensure cohesion between strategic, clinical, and operational strategies within Pharmacy Services to deliver efficient, effective, and high-quality medical pharmacy services to our customers. Performs other duties as assigned.

Key Accountabilities

• Provides oversight and support for all aspects of the medical pharmacy benefit, including elements such as drug policies, clinical services, and utilization management.
• Develops and implements strategies to manage medical drug costs and improve member outcomes consistent across all segments and markets
• Prepares and presents medical drug reviews at Medica's formal approval committee
• Reviews and analyzes medical drug utilization data to ensure optimal usage of medications
• Ensures access to cost-effective medical drugs for our customers
• Develops and implements medical pharmacy policies and procedures
• Ensures compliance with regulatory standards across all segments and markets
• Ensures the efficient and effective delivery of medical pharmacy services for customers
• Represents medical pharmacy services and actively participates in both internal and external cross-functional meetings
• Maintains up-to-date knowledge of new drugs, therapeutic trends, and healthcare laws and regulations
• Maintains accurate and current records of all medical pharmacy decisions and changes
• Addresses inquiries and disputes related to medical pharmacy authorization decisions
• Completes projects as assigned
• Actively participates in internal and external pharmacy meetings

Required Qualifications

• Bachelor's Degree, B.S. Pharmacy or PharmD Required
• 7 years of work experience beyond degree

Required Certifications/Licensure

• Active Pharmacist License

Preferred Qualifications

• 1+ year related work experience specifically focused on medical pharmacy management
• Prior experience with medical pharmacy policy development and utilization management preferred
• Organized and can simultaneously execute through multiple projects and priorities
• Proven track record on consistently achieving desired results
• Self-starter, possessing willingness and ambition to work through ambiguity
• Creative thinker
• Excellent analytical and decision-making skills
• Motivated to problem solve
• Ability to present to an executive audience
• Collaborative, team-oriented spirit
• Excellent written and verbal communication skills
• Customer/patient focused

This position is an Office role, which requires an employee to work onsite, on average, 3 days per week. We are open to candidates located near one of the following office locations: Minnetonka, MN, Madison, WI, Omaha, NE or St. Louis, MO.

The full salary grade for this position is $111,200 - $190,600. While the full salary grade is provided, the typical hiring salary range for this role is expected to be between $111,200 - $166,740. Annual salary range placement will depend on a variety of factors including, but not limited to, education, work experience, applicable certifications and/or licensure, the position's scope and responsibility, internal pay equity and external market salary data. In addition to base compensation, this position may be eligible for incentive plan compensation in addition to base salary. Medica offers a generous total rewards package that includes competitive medical, dental, vision, PTO, Holidays, paid volunteer time off, 401K contributions, caregiver services and many other benefits to support our employees.

The compensation and benefits information is provided as of the date of this posting. Medica's compensation and benefits are subject to change at any time, with or without notice, subject to applicable law.

We are an Equal Opportunity employer, where all qualified candidates receive consideration for employment indiscriminate of race, religion, ethnicity, national origin, citizenship, gender, gender identity, sexual orientation, age, veteran status, disability, genetic information, or any other protected characteristic.