Clinical Program Development Jobs in O Fallon, MO

Medica is a nonprofit health plan with more than a million members that serves communities in Minnesota, Nebraska, Wisconsin, Missouri, and beyond. We deliver personalized health care experiences and partner closely with providers to ensure members are genuinely cared for.

We're a team that owns our work with accountability, makes data-driven decisions, embraces continuous learning, and celebrates collaboration - because success is a team sport. It's our mission to be there in the moments that matter most for our members and employees. Join us in creating a community of connected care, where coordinated, quality service is the norm and every member feels valued.

The Clinical Pharmacist works collaboratively with internal and external stakeholders to advance pharmacy strategy, utilization management, clinical programs, regulatory requirements, and pharmacy performance. This role applies clinical expertise and data analysis to identify opportunities, evaluate pharmacy spend and trend drivers, develop mitigation strategies, and support initiatives that improve clinical and financial outcomes. The role also partners with PBMs on formulary execution and serves as a clinical pharmacy subject matter expert across a matrixed organization. Performs other duties as assigned.

Key Accountabilities

• Monitor pharmacy utilization, spend, and trend performance; identify key cost drivers, emerging patterns, and areas of opportunity across the pharmacy benefit.
• Partner with Analytics and business stakeholders to conduct pharmacy spend and trend analysis, including forecasting, utilization impact assessment, variance analysis, and development of actionable insights.
• Develop and support evidence-based strategies to mitigate adverse pharmacy trends and improve clinical and financial performance, including targeted clinical program and utilization management opportunities.
• Serve as a clinical pharmacy subject matter expert and advisor to internal partners; translate complex pharmacy information and data into clear recommendations for decision makers.
• Oversee and coordinate pharmacy-related operational, regulatory, and compliance activities, including required reporting, submissions, audits, transparency requests, and documentation.
• Collaborate with pharmacy vendors, PBM partners, provider organizations, and other external stakeholders to support effective pharmacy program operations and performance.
• Partner closely with PBM partners on formulary execution, including implementation and maintenance of formulary changes, operational alignment, issue resolution, and ongoing monitoring to ensure intended formulary strategy is accurately executed.
• Identify and communicate targeted performance improvement opportunities across the organization and support implementation through cross-functional collaboration.
• Respond to member, provider, client, and internal stakeholder questions or issues related to pharmacy services in a professional and timely manner.
• Participate in clinical pharmacy meetings, workgroups, and cross-functional initiatives necessary to advance strategic, operational, and performance objectives.
  

Required Qualifications

• Bachelor's degree in Pharmacy required; PharmD preferred or equivalent experience in related field.
• 7+ years of related pharmacy experience beyond degree

Required Certifications/Licensure

• Active Pharmacist license required

Preferred Qualifications

• Experience in pharmacy operations, clinical programs, utilization management, analytics, regulatory affairs, or related health plan/PBM functions preferred.
• Strong knowledge of pharmacy benefit management, formulary execution, clinical pharmacy programs, pharmacy utilization, and the factors that influence pharmacy spend and trend.
• Ability to interpret pharmacy reporting and translate data into meaningful business and clinical insights; proficiency with reporting and data-analysis tools.
• Ability to analyze pharmacy spend, utilization, and trend drivers and develop practical mitigation recommendations.
• Knowledge of applicable regulatory and compliance requirements affecting pharmacy services.
• Strong written, verbal, presentation, and stakeholder communication skills.
• Effective collaborator in matrixed, multi-disciplinary environment with the ability to influence without direct authority.
• High organized; able to manage multiple projects and priorities while maintaining attention to detail.
• Self-starter who works effectively through ambiguity and changing business or regulatory environments.
• Creative, analytical problem solver with a demonstrated track record of achieving results.

This position is an Office role, which requires an employee to work onsite, on average, 3 days per week. We are open to candidates located near one of the following office locations: Minnetonka, MN, Madison, WI, St. Louis, MO, or Omaha, NE.

The full salary grade for this position is $113,400 - $194,400. While the full salary grade is provided, the typical hiring salary range for this role is expected to be between $113,400 - $170,100. Annual salary range placement will depend on a variety of factors including, but not limited to, education, work experience, applicable certifications and/or licensure, the position's scope and responsibility, internal pay equity and external market salary data. In addition to base compensation, this position may be eligible for incentive plan compensation in addition to base salary. Medica offers a generous total rewards package that includes competitive medical, dental, vision, PTO, Holidays, paid volunteer time off, 401K contributions, caregiver services and many other benefits to support our employees.

The compensation and benefits information is provided as of the date of this posting. Medica's compensation and benefits are subject to change at any time, with or without notice, subject to applicable law.

Eligibility to work in the US: Medica does not offer work visa sponsorship for this role. All candidates must be legally authorized to work in the United States at the time of application. Employment is contingent on verification of identity and eligibility to work in the United States.

We are an Equal Opportunity employer, where all qualified candidates receive consideration for employment indiscriminate of race, religion, ethnicity, national origin, citizenship, gender, gender identity, sexual orientation, age, veteran status, disability, genetic information, or any other protected characteristic.