Job Description
Formulary Management Specialist / Manager / Director (PBM Operations) 100% Remote We are seeking a senior-level Formulary Management Specialist with a strong pharmacy background and deep experience in PBM operations, formulary strategy, and formulary disruption assessment. The ideal candidate will have hands-on experience working within or directly under a Pharmacy Benefit Manager (PBM) environment and strong knowledge of Medicare, Medicaid, and CMS regulations. Key Responsibilities: Lead formulary strategy development and optimization initiatives Conduct formulary disruption assessments and analyze member/provider impact Support PBM operations including formulary administration, utilization management, and pharmacy programs Collaborate with CMS, Medicare, and Medicaid stakeholders to ensure regulatory compliance Analyze pharmacy and claims data to support formulary and cost-management decisions Partner with clinical, operations, and compliance teams on formulary implementation and maintenance Provide strategic guidance on drug coverage, tiering, and utilization trends Required Qualifications: PharmD or Pharmacy degree required 8+ years of experience in formulary management and PBM operations Strong experience with Medicare Part D, Medicaid, and CMS guidelines Expertise in formulary strategy, disruption analysis, and pharmacy benefit management Experience working within a PBM organization is highly preferred Strong analytical, operational, and stakeholder management skills