Senior Director, PBM Clinical Operations - Remote

Overview

The Senior Director, PBM Clinical Operations is a senior leader responsible for the strategy, execution, and continuous improvement of Rightway’s core PBM clinical services—including formulary operations, utilization management, and strategic rebate programming. This role oversees operational and clinical performance, drives innovation, and ensures that clinical operations contribute meaningfully to Rightway’s growth and client outcomes.

In Short

• Lead PBM Clinical Operations across formulary management, utilization management, and rebate program execution.
• Define and execute a long-term clinical operations roadmap that improves efficiency, enhances member experience, and supports business objectives.
• Provide executive leadership of the Utilization Management program—including policy development, automation strategy, regulatory readiness, and client alignment.
• Oversee formulary strategy and operations, including design, implementation, and maintenance of core and custom formularies; explore and implement alternative tiering models.
• Serve as clinical lead for rebate strategy and execution; collaborate with manufacturers, rebate aggregators, and clients to optimize financial outcomes.
• Establish operational models that align clinical performance with quality, compliance, and financial goals—including gross margin and client guarantees.
• Collaborate with internal stakeholders in Product, D&I, and Marketing to design and commercialize clinical offerings that meet client and member needs.
• Provide strategic guidance to the P&T Committee, including pipeline insights, formulary recommendations, and clinical impact assessments.
• Drive continuous improvement across clinical workflows to ensure high service levels and enable pharmacists and clinicians to operate at the top of their license.
• Represent Rightway in client-facing engagements, including strategic business reviews, clinical program reporting, and sales support.
• Mentor and develop high-performing clinical and operational leaders.

Requirements

• PharmD required; MBA or related business training preferred.
• 10+ years of progressive experience in pharmacy benefit management or managed care clinical operations.
• Minimum 5 years of executive or senior leadership experience across formulary and UM domains.
• Strong background in Medicare and/or Medicaid program requirements a plus.
• Deep knowledge of formulary development, prior authorization policy, rebate strategy, and clinical program design.
• Exceptional analytical and financial acumen; experience managing toward gross margin targets and operational KPIs.
• Proven ability to scale clinical operations, lead change, and improve outcomes in fast-paced, high-growth environments.
• Executive presence and excellent communication skills; comfortable interfacing with clients and internal leadership.
• Highly collaborative, inclusive leader with a passion for building and empowering teams.
• Strong ownership mindset; thrives in ambiguous, high-accountability settings.

Benefits

• Competitive salary and benefits package.
• Opportunity to lead and innovate in the healthcare space.
• Work with a passionate team dedicated to improving healthcare outcomes.
• Flexible working environment.
• Professional development opportunities.