Senior Clinical Pharmacist

POSITION: Senior Clinical Pharmacist

Who We Are:

OptiMed Health Partners optimizes health outcomes and quality of life through personalized and coordinated care. We have been serving patients for over 30 years with a focus on high-quality care in retail pharmacy, specialty pharmacy, and infusion services. The OptiMed Vision reimagines healthcare solutions to achieve unsurpassed value. Our results-oriented culture fosters learning, providing growth opportunities for our employees and exceptional care for our patients in all 50 states.

The Impact of this Role:

The Senior Clinical Pharmacist serves as a senior clinical leader and medication subject-matter expert, responsible for developing, implementing, and continuously improving clinical strategies that support high-quality, evidence-based, and cost-effective patient care. This role provides oversight of clinical pharmacy programs, utilization management, prior authorization criteria, patient management programs, medication safety, and clinical quality improvement across OptiMed’s pharmacy and PBM business lines. Through collaboration with leadership and operational partners, the Senior Clinical Pharmacist helps improve patient outcomes, promote affordability, maintain compliance, and support organizational growth.

What You’ll be Doing:

Clinical Strategy & Leadership

• Support and execute OptiMed’s overall clinical strategy.
• Serve as a senior clinical advisor to executive leadership and internal teams.
• Develop clinical programs that improve quality, patient outcomes, and total cost of care.
• Monitor emerging clinical evidence, treatment guidelines, therapeutic developments, and market trends.
• Provide leadership in formulary management, specialty pharmacy, specialty infusion, value-based care, and emerging therapies.
• Represent OptiMed with clients, providers, manufacturers, regulators, accrediting organizations, and industry partners.

Prior Authorization & Utilization Management

• Develop and maintain evidence-based prior authorization criteria across applicable therapeutic classes.
• Ensure clinical criteria align with current guidelines, FDA labeling, specialty-society recommendations, and payor objectives.
• Evaluate new medications, biosimilars, and specialty therapies for appropriate utilization-management strategies.
• Recommend changes to step therapy, quantity limits, site-of-care optimization, and specialty pharmacy protocols.
• Monitor approval trends, appeals, provider feedback, and clinical outcomes to improve program effectiveness.
• Participate in complex prior authorization appeals and peer-to-peer reviews.

Patient Management & Clinical Pharmacy Services

• Develop patient management programs and monitoring protocols for specialty medications, chronic conditions, and high-risk therapies.
• Create clinical interventions that improve medication adherence, persistence, safety, and therapeutic outcomes.
• Develop clinical pathways for oncology, autoimmune and inflammatory conditions, rare diseases, obesity, and other relevant populations.
• Establish standards for patient education, clinical outreach, and ongoing therapy management.
• Provide clinical consultation to providers, clients, pharmacists, and care-management teams.
• Support formulary development and evaluate medications for effectiveness, safety, appropriateness, and cost optimization.

Clinical Quality, Compliance & Outcomes

• Partner with Compliance and Quality Management to ensure alignment with URAC, ACHC, state Boards of Pharmacy, and other applicable requirements.
• Develop policies and procedures supporting accreditation and clinical quality standards.
• Monitor clinical quality indicators and implement quality-improvement initiatives.
• Maintain medication-safety and pharmacovigilance processes.
• Support audit readiness and regulatory inspections.
• Use clinical analytics to evaluate program performance, medication utilization, adherence, outcomes, and total cost of care.
• Establish key performance indicators and identify opportunities for program improvement.

Leadership & Team Development

• Mentor and develop pharmacists, pharmacy residents, and clinical staff.
• Promote clinical excellence, innovation, accountability, and continuous improvement.
• Strengthen interdisciplinary collaboration across clinical, operational, and administrative teams.
• Lead strategic clinical initiatives and enterprise-wide projects.

Who You’ll be Working With:

The Senior Clinical Pharmacist reports to the Director of Pharmacy, with support from the Chief Medical Officer. This role works closely with executive leadership, pharmacy operations, PBM teams, Quality Management, Compliance, pharmacists, care-management teams, and other clinical and operational partners. The Senior Clinical Pharmacist also engages with providers, clients, manufacturers, payors, regulatory agencies, accrediting organizations, and industry partners.

Skills and Experience You’ll Bring to the Table:

• Doctor of Pharmacy degree from an accredited program
• Active Michigan pharmacist license in good standing
• Additional state pharmacist licenses preferred
• Minimum of seven years of progressive clinical pharmacy experience
• Minimum of three years of leadership experience
• Experience in PBM, managed care, specialty pharmacy, health plan pharmacy, infusion pharmacy, or clinical program development
• Experience developing prior authorization criteria and utilization-management or patient-management programs
• Experience presenting clinical recommendations to executive leadership and clinical committees
• Relevant board certification, such as BCPS, BCACP, BCOP,BCIDP, BC-ADM, CSP, or another applicable credential preferred
• Knowledge of evidence-based medicine, formulary management, specialty pharmacy, pharmacoeconomics, medication safety, clinical analytics, regulatory compliance, and value-based care

Competencies You’ll Bring to the Table:

• Strategic leadership and clinical excellence
• Critical thinking and sound decision-making
• Executive presence and professional communication
• Collaborative and interdisciplinary leadership
• Patient-centered care and financial stewardship
• Quality improvement and change management
• Regulatory expertise and accountability

Work Environment:

The Senior Clinical Pharmacist works in a professional pharmacy and office environment and regularly uses computers, telephones, and standard office equipment. This role requires frequent in-person and virtual collaboration and may involve occasional travel. Reasonable accommodations may be made in accordance with applicable laws.

OptiMed Health Partners provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.