Clinical Manager, Medicare & Formulary Operations

ABOUT THE ROLE:

We are seeking a Clinical Manager, Medicare & Formulary Operations to lead the development, implementation, and ongoing optimization of Medicare-focused formulary strategies and Commercial operations. This role sits at the intersection of clinical effectiveness, regulatory rigor, and business impact—supporting Medicare Part D compliance, developing and implementing pharmacy operational workflows, and contributing to strategic rebate planning and execution.

You will bring deep subject matter expertise in Medicare and Formulary Operations—including MTM programs, formulary compliance, and audit readiness—while applying strong clinical and analytical skills to formulary design and rebate evaluation. This role works cross-functionally across Clinical, Product, Data & Insights, and Marketing to evolve Rightway’s formulary offerings and support our Pharmacy & Therapeutics (P&T) Committee.

WHAT YOU’LL DO:

• Support the design, implementation, and maintenance of Rightway’s Medicare and Commercial formularies, including client-specific and standard drug offerings.
• Collaborate with the claims platform team to ensure accurate formulary coding and functionality; support regular formulary testing and validation.
• Oversee formulary operations, ensuring alignment with regulatory standards and audit readiness.
• Serve as a clinical and strategic partner in rebate-related activities—collaborating with rebate aggregators, pharmaceutical manufacturers, and health plans—and provide clinical input into financial modeling and evaluations.
• Apply clinical effectiveness data and analytical tools to inform formulary decisions and strategies.
• Contribute to and support Rightway’s P&T Committee with strategic insights, drug evaluations, and formulary performance updates.
• Partner with Product, D&I, and Marketing to evolve our formulary solutions and bring them to market in ways that enhance the member experience.
• Facilitate communication to and education of clients, members, and internal staff regarding clinical issues and objectives
• Provide support to operational teams and clients during implementation
• Support RFI and RFP submissions, as required

WHO YOU ARE:

• • Pharmacist licensed in the state in which you reside. 
  • 5+ years of pharmacy operations experience working within a health plan or PBM, with 3+ years of Medicare formulary operations experience. 
  • Moderate to high-level expertise in MS Excel
  • Strong background in formulary coding within a PBM platforms
  • Strong demonstrable expertise in pharmacy operations, including identifying and eliminating operational inefficiencies. 
  • Deep understanding of formulary development, implementation, and oversight processes.
  • Experience working with rebate aggregators or manufacturers in formulary and rebate strategy.
  • Highly analytical, with the ability to use data and clinical insights to guide formulary strategy and decision-making.
  • Strong collaborator and communicator, with the ability to work cross-functionally and influence stakeholders.
  • Comfortable operating in a fast-paced, evolving environment with a proactive, ownership-oriented mindset.

SALARY: $140,000-160,000

Offer amounts for both remote and in office roles are influenced by geographic location.

CYBERSECURITY AWARENESS NOTICE

In response to ongoing and industry-wide fraudulent recruitment activities (i.e., job scams), Rightway wants to inform potential candidates that we will only contact them from the @rightwayhealthcare.com email domain. We will never ask for bank details or deposits of any kind as a condition of employment. 

ABOUT RIGHTWAY:

Rightway is on a mission to harmonize healthcare for everyone, everywhere. Our products guide patients to the best care and medications by inserting clinicians and pharmacists into a patient’s care journey through a modern, mobile app. Rightway is a front door to healthcare, giving patients the tools they need along with on-demand access to Rightway health guides, human experts that answer their questions and manage the frustrating parts of healthcare for them.

Since its founding in 2017, Rightway has raised over $205mm from investors including Khosla Ventures, Thrive Capital, and Tiger Global. We’re headquartered in New York City, with satellite offices in Denver and Dallas. Our clients rely on us to transform the healthcare experience, improve outcomes for their teams, and decrease their healthcare costs.

HOW WE LIVE OUR VALUES TO OUR TEAMMATES:

We’re seeking those with passion for healthcare and relentless devotion to our goal. We need team members that embody our following core values:

1) We are human, first
Our humanity binds us together. We bring the same empathetic approach to every individual we engage with, whether it be our members, our clients, or each other. We are all worthy of respect and understanding and we engage in our interactions with care and intention. We honor our stories. We listen to—and hear—each other, we celebrate our differences and similarities, we are present for each other, and we strive for mutual understanding.

2) We redefine what is possible
We always look beyond the obstacles in front of us to imagine new solutions. We approach our work with inspiration from other industries, other leaders, and other challenges. We use ingenuity and resourcefulness when faced with tough problems.

3) We debate then commit
We believe that a spirit of open discourse is part of a healthy culture. We understand and appreciate different perspectives and we challenge our assumptions. When working toward a decision or a new solution, we actively listen to one another, approach it with a “yes, and” mentality, and assume positive intent. Once a decision is made, we align and champion it as one team.

4) We cultivate grit
Changing healthcare doesn’t happen overnight. We reflect and learn from challenges and approach the future with a determination to strive for better. In the face of daunting situations, we value persistence. We embrace failure as a stepping stone to future success. On this journey, we seek to act with guts, resilience, initiative, and tenacity.

5) We seek to delight
Healthcare is complicated and personal. We work tirelessly to meet the goals of our clients while also delivering the best experience to our members. We recognize that no matter the role or team, we each play a crucial part in our members’ care and take that responsibility seriously. When faced with an obstacle, we are kind, respectful, and solution-oriented in our approach. We hold ourselves accountable to our clients and our members’ success.

Rightway is Proudly an Equal Opportunity Employer that believes in strength in the diversity of thought processes, beliefs, background and education and fosters an inclusive culture where differences are celebrated to drive the best business decisions possible. We do not discriminate on any basis covered by appropriate law. All employment is decided on the consideration of merit, qualifications, need and performance.