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Clinical Formulary Specialist - Job Opportunity at CGC Group Inc.

Plantation, United States
Contract
Senior
Posted: March 30, 2025
Remote
USD 135,200 - 156,000 per year

Benefits

Comprehensive healthcare package including dental and vision coverage with competitive market rates
Financial security through STD/LTD and Life/AD&D insurance offerings
Modern workplace benefits including Health Advocate EAP and Health Equity Commuter Benefits
Future-focused retirement planning with 401(k) program
Work-life balance support through flexible payment options (ZayZoon) and EAP services

Key Responsibilities

Strategic management of 300+ medical policies annually with focus on regulatory compliance and clinical excellence
Lead vendor collaboration for rebate requirement compliance and policy optimization
Executive-level participation in Restricted Recipient Committee with comprehensive medication review authority
Development and presentation of clinical recommendations affecting formulary decisions
Oversight of member communication and quality assurance processes
Strategic participation in new drug evaluation and formulary placement decisions
Regulatory compliance management for Medicaid and state requirements

Requirements

Education

Bachelor's degree in Pharmacy, Healthcare Administration, or related field required; PharmD or Master's degree preferred

Experience

Minimum of 5 years of experience in formulary management, regulatory compliance, or related healthcare operations

Required Skills

Strong knowledge of formulary management, medical policy development, and regulatory compliance Experience with Medicaid, Medicare, and other government healthcare programs Expertise in pharmacy benefits, claim adjudication, and rebate compliance Strong analytical and problem-solving skills Excellent communication and presentation skills Project management capabilities Proficiency in PBM reporting platforms and healthcare technology systems Strong proficiency in Microsoft Office Suite and data analysis tools
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Sauge AI Market Intelligence

Industry Trends

Healthcare cost management is driving increased focus on formulary optimization and specialty drug management, creating higher demand for specialists who can balance clinical efficacy with cost-effectiveness Regulatory complexity in healthcare is expanding, particularly around Medicare and Medicaid requirements, necessitating deeper expertise in compliance Digital transformation in healthcare is pushing for more sophisticated drug utilization review processes and data-driven formulary decisions

Salary Evaluation

The offered salary range of $135,200-156,000 annually is competitive for senior formulary specialists, reflecting the high-level expertise required and the remote work option. Market rates typically range from $120,000 to $170,000 for similar roles.

Role Significance

Typically operates within a specialized team of 5-8 pharmacy and healthcare professionals, collaborating across multiple departments
Senior strategic position with direct impact on organizational compliance and financial performance through formulary management and policy development

Key Projects

Annual formulary strategy development and optimization Regulatory compliance initiatives and audit preparation Cost containment programs through strategic drug placement and utilization management Clinical policy modernization and standardization projects

Success Factors

Deep understanding of both clinical and business aspects of formulary management Strong regulatory compliance knowledge and ability to anticipate policy changes Excellence in stakeholder management and cross-functional collaboration Advanced analytical capabilities for complex healthcare data interpretation

Market Demand

High demand with growing complexity in healthcare regulations and cost management pressures. Specialized knowledge in both clinical and regulatory aspects makes this role increasingly valuable.

Important Skills

Critical Skills

Advanced knowledge of pharmacy benefit management and formulary optimization Regulatory compliance expertise across multiple healthcare programs Strategic thinking and decision-making capabilities Strong data analysis and interpretation skills

Beneficial Skills

Project management certification Advanced degrees in pharmacy or healthcare administration Experience with multiple PBM platforms Knowledge of emerging healthcare technology trends

Unique Aspects

Combination of clinical expertise and regulatory compliance responsibilities
Significant autonomy in policy development and formulary management
Direct impact on organizational cost management and clinical outcomes

Career Growth

2-4 years in role typical before advancement to director-level positions, depending on organizational structure and performance

Potential Next Roles

Director of Pharmacy Benefits Senior Manager of Clinical Programs Pharmacy Operations Director Healthcare Compliance Director

Company Overview

CGC Group Inc.

CGC Group Inc. appears to be a healthcare services organization focusing on managed care and pharmacy benefit solutions

Mid-sized player in the healthcare services sector with growing presence in pharmacy benefit management
National scope with focus on remote workforce capabilities
Progressive remote-first environment with emphasis on work-life balance and professional development
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  • Industry trends and market dynamics
  • Salary estimates and market demand analysis
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  • Critical success factors and key skills
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