Clinical Consulting and Plan Performance Manager

The Clinical Consulting and Plan Performance Manager is a vital role focused on elevating clinical consulting services and enhancing the performance of our partner plans. You will engage with both internal teams and external partners to spearhead initiatives that improve clinical outcomes, drive cost efficiency, and ensure overall plan success. As a subject matter expert, you will provide essential clinical guidance and collaborate across departments to achieve client objectives.

Leadership and Strategy:

• Support the development and execution of innovative strategies to achieve client plan performance goals.
• Serve as a clinical expert to the client services team, offering operational insights and day-to-day management support.
• Work with internal leaders to integrate clinical consulting initiatives with organizational priorities.

Clinical Consulting Services:

• Deliver exceptional clinical consulting services to clients, ensuring recommendations are evidence-based.
• Contribute to the design and implementation of clinical programs aimed at enhancing patient outcomes and supporting client objectives.
• Engage in clinical discussions with clients during sales, implementations, and operations, focusing on how benefit designs and clinical programs influence financial performance.

Plan Performance Optimization:

• Examine pharmacy benefit plan performance metrics to detect trends and opportunities for enhancement.
• Collaborate with internal teams to develop and execute performance improvement strategies, reporting on results.
• Provide continuous support and direction to the client services team in managing client relationships and performance metrics.

Stakeholder Collaboration:

• Establish and nurture effective relationships with clients, internal teams, and external partners.
• Act as a resource for the client services team on clinical strategies and performance improvement discussions with clients.
• Participate in client meetings, presentations, and consultations to foster ongoing engagement.
• Facilitate clear communication and alignment between clients and internal teams regarding goals.

Compliance and Quality Assurance:

• Support quality assurance initiatives to ensure the precision and effectiveness of clinical consulting services.
• Stay informed on industry developments and best practices in pharmacy, PBM, and healthcare to promote ongoing improvement.

Who You Are:

• PharmD or equivalent degree from an accredited institution.
• Active pharmacist license in good standing.
• Minimum of 3 years of experience in PBM, health plan, pharmacy clinical consulting, or a similar field.
• Demonstrated ability to manage projects and collaborate effectively across multifunctional teams.
• Strong analytical abilities with a knack for interpreting data and generating actionable insights.
• Excellent communication and interpersonal skills to build rapport with clients and internal stakeholders.
• In-depth knowledge of pharmacy benefit management and clinical pharmacy practices.

Preferred Qualifications:

• Experience with project management and process improvement methodologies.
• Managed Care Pharmacy Residency, MBA, MPH, or a related advanced degree is a plus.
• Prior experience with health plans or PBMs is advantageous.

Salary: $100,000 - $130,000 (before bonus potential). Offer amounts for both remote and in-office roles are influenced by geographic location.

Working Conditions:

• Remote-based with occasional travel for client meetings, conferences, and professional development.

Cybersecurity Awareness Notice: Rightway will only communicate with candidates using the @rightwayhealthcare.com email domain and will never request bank details or deposits as part of the hiring process.

About Rightway: Rightway’s mission is to harmonize healthcare access for everyone. Our innovative products guide patients through their care journey by providing critical support from clinicians and pharmacists. Founded in 2017, Rightway has secured over $205 million from investors and is headquartered in New York City with additional offices in Denver and Dallas.

Our Core Values: We value treatment of all individuals with humanity, continuously seek innovative solutions, engage in constructive discourse, cultivate resilience, and prioritize exceptional experiences for both clients and members.

Rightway is an equal opportunity employer that champions diversity and inclusivity within our workforce. We evaluate all employment decisions based on merit, achievements, and performance, without discrimination based on any legally protected characteristics.