Clinical Pharmacist – Formulary Management Regulatory
Clinical Pharmacist – Formulary Management Regulatory
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Job Description
Job Title: Clinical Pharmacist Formulary Management Regulatory
Company Overview:
Pulivarthi Group is a premier global provider of staffing and IT technology solutions renowned for delivering exceptional services tailored to each clients unique needs. With a steadfast commitment to excellence we merge expertise with innovation ensuring cost-effective solutions of the highest quality. Our diverse client base spans healthcare finance government and beyond reflecting our adaptability and proficiency across industries. Operating in the United States Canada and Mexico we pride ourselves on aligning with clients cultures deploying top-tier talent and utilizing cutting-edge technologies. Pulivarthi Group stands as a beacon of reliability efficiency and innovation in the realm of staffing solutions.
Job Overview/Summary:
We are seeking a Clinical Pharmacist Formulary Management Regulatory to join our clients formulary management team. This role combines clinical pharmacy expertise with regulatory compliance to ensure template formularies utilization management (UM) criteria and processes align with MHPAEA and federal/state regulations. The position also supports audits market checks and cross-functional collaboration to maintain compliance and optimize formulary strategies.
Key Responsibilities:
Regulatory Compliance & Audits
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Ensure template formularies and UM criteria align with MHPAEA and all applicable federal/state regulations.
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Support PBM market conduct examinations CMS audits and internal regulatory reviews.
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Partner with Government Affairs Legal and Compliance teams to produce and validate data for exam requests.
Formulary Management
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Develop and maintain template formularies including drug tiering and UM application that meet or exceed regulatory requirements.
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Evaluate consistency in UM application across medical/surgical and mental health/substance use disorder drugs.
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Identify evidentiary standards factors and sources supporting Non-Quantitative Treatment Limitations (NQTLs).
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Provide QA and sign-off on audit responses and corrective action plans.
Utilization Management
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Understand UM processes including prior authorization step therapy quantity limits and formulary exceptions.
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Ensure UM decisions reflect clinical best practices and regulatory requirements.
Cross-Functional Collaboration
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Act as liaison between Formulary Management and internal/external stakeholders including Client Audit Team Legal Compliance and Regulatory Affairs.
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Collaborate in a matrixed environment with colleagues across departments and levels.
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Present findings and recommendations to leadership and regulatory partners.
Primary Skills:
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Strong understanding of MHPAEA CMS regulations and market conduct exam processes.
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Demonstrated expertise in utilization management interventions (prior authorization step therapy quantity limits formulary exceptions).
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Proven ability to perform literature searches and evidence-based medicine analysis.
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Excellent communication skills with the ability to distill complex concepts for leadership.
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Project and process management experience with ability to optimize complex workflows.
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Proficiency in MS Office applications (Word Excel Access PowerPoint).
Preferred Skills (Good to Have):
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Experience supporting audits and regulatory reviews in a PBM or managed care setting.
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Familiarity with mental health and substance use disorder treatment guidelines.
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Knowledge of Specialty Pharmacy Utilization Management and Formulary Management.
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Experience managing complex projects and cross-functional initiatives.
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Knowledge of regulatory rules and requirements across state and federal levels.
Qualifications:
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BS in Pharmacy or PharmD required.
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Active pharmacist license in good standing.
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3 5 years of experience in regulatory pharmacy utilization management or PBM operations.
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3 years of managed care experience.
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3 years of relevant UM or prior authorization experience.
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Ability to work 3 days per week onsite at Buffalo Grove IL or Pittsburgh PA office locations (hybrid structure).
What We Offer:
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Opportunity to work with a leading PBM and managed care organization.
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Competitive salary and benefits package.
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Ability to influence formulary management strategies impacting diverse populations.
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A values-driven organization prioritizing compliance innovation and collaboration.
Additional Requirements:
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Candidates must be able to provide proof of eligibility to work in the United States.
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Background check and drug screening may be required based on position requirements.
Equal Opportunity Statement:
Pulivarthi Group is proud to be an equal opportunity employer. We are committed to building a diverse and inclusive culture and celebrate authenticity. We do not discriminate on the basis of race religion color national origin gender gender identity sexual orientation age marital status disability protected veteran status or any other legally protected characteristics.
Employment Type
Full-time
