• Design, build and own comprehensive clinical programs (e.g., GLP-1 weight loss management, opioid management, fraud/waste/abuse detection) • Define clinical policy and intent behind prior authorization criteria and utilization management controls • Serve as the internal clinical authority and point of contact for complex clinical questions and policy decisions • Translate clinical guidelines and evidence into actionable interventions that balance member access with cost management • Design, implement, and maintain drug formularies that balance clinical efficacy, safety, and cost-effectiveness with lowest net cost strategies • Conduct therapeutic class reviews and drug evaluations using evidence-based clinical criteria • Manage formulary updates in response to new drug approvals, pipeline changes, and evolving clinical evidence • Develop and manage PA criteria that are clinically sound, medication-specific, and operationally effective • Lead Formulary Navigator buildout and drive automation of drug list processes • Partner with Analytics team on targeting logic, intervention design, and performance dashboards • Support client-facing clinical discussions and explain coverage rationale with clinical credibility