Job description
ABOUT THE ROLE:
We are seeking a Senior Manager, Clinical Medicare & Formulary Operations to lead the development, implementation, and ongoing optimization of Medicare-focused formulary strategies and operations. This role sits at the intersection of clinical effectiveness, regulatory rigor, and business impact—supporting Medicare Part D compliance, managing formulary workflows, and contributing to strategic rebate planning and execution.
You will bring deep subject matter expertise in Medicare—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:
- Lead the design, deployment, and maintenance of Rightway’s formularies, including custom and standard drug lists.
- Oversee Medicare formulary operations, ensuring alignment with regulatory standards and audit readiness, including support for Medication Therapy Management (MTM) and CMS compliance.
- Monitor and analyze regulatory and legislative requirements, develop project plans to meet requirements, and lead cross functional teams to implement programs to meet requirements
- 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.
- Collaborate with the claims platform team to ensure accurate formulary coding and functionality; support regular formulary testing and validation.
- 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
- Explore and support the implementation of non-traditional formulary designs that move beyond tier-based structures.
- Support RFI and RFP submissions, as required
- Mentor or oversee team members as appropriate; people leadership experience is preferred.
WHO YOU ARE:
- PharmD required.
- 5+ years of pharmacy experience working for a health plan or PBM with 3+ years of Medicare experience. Strong expertise in formulary operations and regulatory requirements.
- Deep understanding of formulary development, CMS compliance, MTM programs, and Medicare audit 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.
- Familiar with formulary coding in PBM platforms and claims testing processes.
- Strong collaborator and communicator, with the ability to work cross-functionally and influence stakeholders.
- Experience with people leadership or mentoring preferred.
- Comfortable operating in a fast-paced, evolving environment with a proactive, ownership-oriented mindset.
SALARY:
$130,000-$140,000/yr
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 $130mm from investors including Khosla Ventures, Thrive Capital, and Tiger Global at a valuation of $1 billion. We’re headquartered in New York City, with a satellite office in Denver. 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:
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.
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.
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.
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.
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 a healthcare company looking to improve healthcare outcomes for everyone, everywhere. With that in mind, we have to consider what is good for the health of our team, the company, and the communities we operate in. As such, Rightway has determined a mandatory COVID-19 vaccination policy for all employees, in combination with other safety precautions, is the best way forward.
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.
