Clinical Account Director - Pharmacy Benefits
About the Opportunity
A rapidly growing healthcare consulting organization is seeking a Clinical Account Director to lead strategic pharmacy benefit consulting engagements for employer-sponsored health plans. This role combines client management, clinical advisory services, pharmacy analytics, vendor oversight, and PBM consulting to help organizations optimize their pharmacy benefit programs, improve outcomes, and control costs.
This is an opportunity to join a highly respected consulting environment that partners with employers, brokers, TPAs, health systems, and health plans to navigate the evolving pharmacy benefits landscape. The organization offers a collaborative culture, strong professional development opportunities, and a flexible work environment.
Position Overview
The Clinical Account Director serves as the primary clinical consultant and strategic partner for clients, overseeing pharmacy benefit program performance, PBM relationships, clinical initiatives, and cost-management strategies. The role requires a deep understanding of pharmacy benefits, formulary management, specialty pharmacy, and healthcare market trends.
Key Responsibilities
Client Consulting & Account Management
- Lead ongoing client relationships and serve as a trusted pharmacy benefits advisor.
- Coordinate client meetings, establish agendas, and manage follow-up action items.
- Interpret complex pharmacy benefit designs and resolve benefit, claims, and enrollment issues.
- Conduct client presentations, performance reviews, and occasional onsite meetings.
- Monitor regulatory and legislative developments impacting pharmacy benefits and compliance.
Analytics & Reporting
- Analyze pharmacy claims data, utilization trends, and cost drivers.
- Deliver routine reporting, trend analyses, and annual performance reviews.
- Manage reconciliation and market-check processes.
- Partner with clinical and analytics teams to identify opportunities for improved outcomes and cost savings.
PBM & Vendor Management
- Oversee PBM relationships and operational performance.
- Resolve vendor-related issues and ensure service expectations are met.
- Support transitions, implementations, and program enhancements.
- Participate in evaluations and selection processes for pharmacy benefit vendors and consulting solutions.
Clinical Strategy & Advisory Services
- Provide guidance related to formulary management and pharmacy benefit strategy.
- Support Pharmacy & Therapeutics (P&T) initiatives.
- Advise clients on emerging therapies, specialty medications, and high-cost drug management strategies.
- Evaluate financial and clinical implications of pharmacy programs and benefit design decisions.
- Assist clients in navigating complex pharmacy reimbursement and pricing considerations.
Qualifications
- PharmD Required; pharmacy degree required.
- 5+ years of pharmacy experience, with managed care, PBM, pharmacy consulting, or pharmacy benefit management experience strongly preferred.
- Strong understanding of pharmacy benefit plan design, formulary management, and healthcare industry trends.
- Experience presenting complex clinical and financial information to clients and stakeholders.
- Exceptional analytical, problem-solving, and client relationship management skills.
- Ability to manage multiple projects and priorities simultaneously.
- Strong proficiency with Excel, PowerPoint, Word, and data analysis tools.
- Familiarity with healthcare compliance requirements, including HIPAA and PHI regulations.
FAQs
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