• Serve as the primary pharmacy clinical lead for our PBM partnership, including oversight of utilization management, formulary and clinical programs • Design, implement and manage clinical programs that drive affordability, quality, and member outcomes • Provide clinical oversight of pharmacy vendors and clinical programs that improve outcomes and reduce unnecessary utilization • Own formulary design and maintenance, including tier strategy, drug placement, therapeutic class management, and clinical edit logic • Complete reviews of prior authorization decisions and appeals for specialty and non-specialty drugs • Develop and maintain policies related to clinical pharmacy and both pharmacy and medical benefit drugs • Collaborate with actuarial, finance, and product teams to inform pricing, trend modeling, pharmacy spend forecasting, and stop-loss considerations • Partner cross-functionally with product, clinical, network, actuarial and other stakeholders to ensure integrated care approaches • Ensure compliance with applicable regulatory, accreditation, and clinical governance standards, maintaining high ethical and quality standards