Clinical Account Consultant - PBM

Position Summary:

The Clinical Account Consultant (CAC) is a clinical subject matter expert behind a portfolio of pharmacy benefit
management clients. Responsibilities include turning complex claims data, clinical guidelines, and market shifts into
clear, data-driven recommendations. This role partners closely with Account Executives and internal teams to
improve member outcomes and pharmacy benefit performance across the client lifecycle.

Position Responsibilities:

Shape Clinical Strategy

• Analyze pharmacy claims, utilization, and drug trend data to surface insights and build evidence-based
  recommendations across formulary, utilization management, specialty, and clinical programs.
• Translate treatment guidelines, pipeline developments, and market trends into client strategy and assess
  its clinical impact.

Drive Clinical Program Execution & Client Delivery

• Operationalize approved recommendations with internal teams so clinical intent is accurately reflected in
  formulary changes, utilization management initiatives, and other pharmacy benefit enhancements.
• Review disruption analyses, clinical readiness materials, and post-go-live outputs to support accurate
  execution and a strong client/member experience.
• Build client-ready clinical content for quarterly business reviews, strategic reviews, renewals, finalist
  presentations, and other client needs – then present findings and field clinical questions directly.

Build to Scale

• Partner with Account Executives, analytics, operations, product, and other internal teams to align clinical
  strategy with operational execution and platform capabilities.
• Contribute to the development of standardized clinical tools, templates, and best practices that raise
  quality, efficiency, and consistency across the team.

Additional Responsibilities

• Support general business and team needs, as required.
• Certain times of year may require meeting participation, testing, claims review, or other support outside of
  standard business hours, including weekends.

Required Qualifications:

• Doctor of Pharmacy (PharmD) degree from an accredited institution.
• Active pharmacist license, or ability to obtain/maintain licensure as required.
• 3–5 years of experience in PBM, managed care, or health plan environments.
• Strong clinical knowledge of formulary management, utilization management, clinical programs, and
  pharmacy trend analysis.
• Experience analyzing pharmacy claims data and translating findings into actionable clinical
  recommendations.
• Ability to explain complex clinical concepts clearly to both clinical and non-clinical audiences.
• Strong written and verbal communication skills.
• Highly organized and able to manage multiple priorities in a fast-paced, cross-functional environment.
• Proficiency in Microsoft Office Suite, including Excel, and experience working with large data sets.
• Ability to travel and present to small and large groups; travel is estimated not to exceed 25%.

Preferred Qualifications

• Experience supporting formulary strategies, utilization management programs, or specialty pharmacy
  initiatives.
• Experience contributing to client-facing clinical presentations and strategic recommendations.
• Familiarity with implementation support related to formulary strategy, disruption review, or clinically
  driven benefit setup.
• Experience working in a highly collaborative, matrixed environment.