Clinical Manager, Medicare & Formulary Operations

ABOUT THE ROLE:

We are seeking a Clinical Manager Medicare & Formulary Operations to lead the development implementation and ongoing optimization of Medicare-focused formulary strategies and Commercial operations. This role sits at the intersection of clinical effectiveness regulatory rigor and business impactsupporting Medicare Part D compliance developing and implementing pharmacy operational workflows and contributing to strategic rebate planning and execution.

You will bring deep subject matter expertise in Medicare and Formulary Operationsincluding MTM programs formulary compliance and audit readinesswhile applying strong clinical and analytical skills to formulary design and rebate evaluation. This role works cross-functionally across Clinical Product Data & Insights and Marketing to evolve Rightways formulary offerings and support our Pharmacy & Therapeutics (P&T) Committee.

WHAT YOULL DO:

• Support the design implementation and maintenance of Rightways Medicare and Commercial formularies including client-specific and standard drug offerings.
• Collaborate with the claims platform team to ensure accurate formulary coding and functionality; support regular formulary testing and validation.
• Oversee formulary operations ensuring alignment with regulatory standards and audit readiness.
• Serve as a clinical and strategic partner in rebate-related activitiescollaborating with rebate aggregators pharmaceutical manufacturers and health plansand provide clinical input into financial modeling and evaluations.
• Apply clinical effectiveness data and analytical tools to inform formulary decisions and strategies.
• Contribute to and support Rightways P&T Committee with strategic insights drug evaluations and formulary performance updates.
• Partner with Product D&I and Marketing to evolve our formulary solutions and bring them to market in ways that enhance the member experience.
• Facilitate communication to and education of clients members and internal staff regarding clinical issues and objectives
• Provide support to operational teams and clients during implementation
• Support RFI and RFP submissions as required

WHO YOU ARE:

• • Pharmacist licensed in the state in which you reside.
  • 5 years of pharmacy operations experience working within a health plan or PBM with 3 years of Medicare formulary operations experience.
  • Moderate to high-level expertise in MS Excel
  • Strong background in formulary coding within a PBM platforms
  • Strong demonstrable expertise in pharmacy operations including identifying and eliminating operational inefficiencies.
  • Deep understanding of formulary development implementation and oversight processes.
  • Experience working with rebate aggregators or manufacturers in formulary and rebate strategy.
  • Highly analytical with the ability to use data and clinical insights to guide formulary strategy and decision-making.
  • Strong collaborator and communicator with the ability to work cross-functionally and influence stakeholders.
  • Comfortable operating in a fast-paced evolving environment with a proactive ownership-oriented mindset.

SALARY: $00

Offer amounts for both remote and in office roles are influenced by geographic location.

CYBERSECURITY AWARENESS NOTICE

In response to ongoing and industry-wide fraudulent recruitment activities (i.e. job scams) Rightway wants to inform potential candidates that we will only contact them from the @ email domain. We will never ask for bank details or deposits of any kind as a condition of employment.

ABOUT RIGHTWAY:

Rightway is on a mission to harmonize healthcare for everyone everywhere. Our products guide patients to the best care and medications by inserting clinicians and pharmacists into a patients care journey through a modern mobile app. Rightway is a front door to healthcare giving patients the tools they need along with on-demand access to Rightway health guides human experts that answer their questions and manage the frustrating parts of healthcare for them.

Since its founding in 2017 Rightway has raised over $205mm from investors including Khosla Ventures Thrive Capital and Tiger Global. Were headquartered in New York City with satellite offices in Denver and Dallas. Our clients rely on us to transform the healthcare experience improve outcomes for their teams and decrease their healthcare costs.

HOW WE LIVE OUR VALUES TO OUR TEAMMATES:

Were seeking those with passion for healthcare and relentless devotion to our goal. We need team members that embody our following core values:

1) We are human first
Our humanity binds us together. We bring the same empathetic approach to every individual we engage with whether it be our members our clients or each other. We are all worthy of respect and understanding and we engage in our interactions with care and intention. We honor our stories. We listen toand heareach other we celebrate our differences and similarities we are present for each other and we strive for mutual understanding.

2) We redefine what is possible
We always look beyond the obstacles in front of us to imagine new solutions. We approach our work with inspiration from other industries other leaders and other challenges. We use ingenuity and resourcefulness when faced with tough problems.

3) We debate then commit
We believe that a spirit of open discourse is part of a healthy culture. We understand and appreciate different perspectives and we challenge our assumptions. When working toward a decision or a new solution we actively listen to one another approach it with a yes and mentality and assume positive intent. Once a decision is made we align and champion it as one team.

4) We cultivate grit
Changing healthcare doesnt happen overnight. We reflect and learn from challenges and approach the future with a determination to strive for the face of daunting situations we value persistence. We embrace failure as a stepping stone to future success. On this journey we seek to act with guts resilience initiative and tenacity.

5) We seek to delight
Healthcare is complicated and personal. We work tirelessly to meet the goals of our clients while also delivering the best experience to our members. We recognize that no matter the role or team we each play a crucial part in our members care and take that responsibility seriously. When faced with an obstacle we are kind respectful and solution-oriented in our approach. We hold ourselves accountable to our clients and our members success.

Rightway is Proudly an Equal Opportunity Employer that believes in strength in the diversity of thought processes beliefs background and education and fosters an inclusive culture where differences are celebrated to drive the best business decisions possible. We do not discriminate on any basis covered by appropriate law. All employment is decided on the consideration of merit qualifications need and performance.