Senior Director, PBM Clinical Operations

ABOUT THE ROLE

The Senior Director, PBM Clinical Operations is a senior leader responsible for the strategy, execution, and continuous improvement of Rightway’s core PBM clinical services—including formulary operations, utilization management, and strategic rebate programming. This role oversees operational and clinical performance, drives innovation, and ensures that clinical operations contribute meaningfully to Rightway’s growth and client outcomes.

You will lead a multidisciplinary team and collaborate across the organization—partnering with Product, Data & Insights, and Commercial teams—to launch and refine differentiated clinical offerings. You will also serve as a primary clinical voice for external partners and clients, helping to position Rightway as a high-value PBM partner focused on delivering the Triple Aim: improved member experience, better health outcomes, and lower costs.

This role has executive oversight of the Utilization Management program and formulary strategy, ensuring operational excellence, regulatory compliance, and strong alignment to financial and clinical goals.

WHAT YOU’LL DO

• Lead PBM Clinical Operations across formulary management, utilization management, and rebate program execution.
• Define and execute a long-term clinical operations roadmap that improves efficiency, enhances member experience, and supports business objectives.
• Provide executive leadership of the Utilization Management program—including policy development, automation strategy, regulatory readiness, and client alignment.
• Oversee formulary strategy and operations, including design, implementation, and maintenance of core and custom formularies; explore and implement alternative tiering models.
• Serve as clinical lead for rebate strategy and execution; collaborate with manufacturers, rebate aggregators, and clients to optimize financial outcomes.
• Establish operational models that align clinical performance with quality, compliance, and financial goals—including gross margin and client guarantees.
• Collaborate with internal stakeholders in Product, D&I, and Marketing to design and commercialize clinical offerings that meet client and member needs.
• Provide strategic guidance to the P&T Committee, including pipeline insights, formulary recommendations, and clinical impact assessments.
• Drive continuous improvement across clinical workflows to ensure high service levels and enable pharmacists and clinicians to operate at the top of their license.
• Represent Rightway in client-facing engagements, including strategic business reviews, clinical program reporting, and sales support.
• Mentor and develop high-performing clinical and operational leaders.

WHO YOU ARE

• PharmD required; MBA or related business training preferred.
• 10+ years of progressive experience in pharmacy benefit management or managed care clinical operations.
• Minimum 5 years of executive or senior leadership experience across formulary and UM domains.
• Strong background in Medicare and/or Medicaid program requirements a plus.
• Deep knowledge of formulary development, prior authorization policy, rebate strategy, and clinical program design.
• Exceptional analytical and financial acumen; experience managing toward gross margin targets and operational KPIs.
• Proven ability to scale clinical operations, lead change, and improve outcomes in fast-paced, high-growth environments.
• Executive presence and excellent communication skills; comfortable interfacing with clients and internal leadership.
• Highly collaborative, inclusive leader with a passion for building and empowering teams.
• Strong ownership mindset; thrives in ambiguous, high-accountability settings.

BASE SALARY: $180,000-120,000

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 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:

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.