The Role
Provide clinical consultation to prescribers and members, review and validate AI-generated medication recommendations, manage formulary and site-of-care optimization, reconcile polypharmacy cases, build clinical SOPs and quality metrics, and shape product and clinical operations as an early clinical leader.
Summary Generated by Built In
About Tokaido Health
Tokaido Health is an AI-native medication navigation platform for self-insured employers. We span the pharmacy and medical benefit, combining infusion site-of-care navigation, formulary optimization, fulfillment alternatives, and embedded clinical intelligence into a single platform. We deploy behavioral economics–driven incentives to drive real behavior change and deliver win-win recommendations for our members and plan sponsors. This is the first dedicated clinical pharmacist role on our team.
The Role
You will be the clinical voice of Tokaido — the person on the phone with members when they have questions, the person on the phone with prescribers explaining why a biosimilar or a complex therapeutic interchange makes clinical and economic sense. You will also review AI-derived medication recommendations before they reach a member and stress-test our clinical algorithms against real-world clinical judgment. You will be building the clinical operations playbook alongside the Chief Medical Officer and shaping the product as an early member of the core team.
At launch, you will focus on improving the clinical performance of our MVP and on supporting our first client engagement. As we add clients, this role grows into a clinical leadership position with responsibility for additional pharmacists and clinical reviewers.
What You’ll Do
- Prescriber engagement: Conduct peer-to-peer clinical consultations with prescribing providers to recommend formulary alternatives, biosimilar switches, and site-of-care transitions (for infusions). You are the clinical peer who makes the case and supports members who are often hesitant to engage in these conversations independently.
- Member engagement: Answer member questions regarding their medications. Help them understand their options and optimize for costs, safety, and efficacy. Explain and mitigate risks from polypharmacy. Support them in having the right conversations with their prescribers, sometimes even having those conversations on their behalf (with appropriate consent).
- Formulary optimization review: Review AI-generated formulary optimization recommendations (brand-to-generic substitutions, therapeutic alternatives, combination splits, etc) for clinical appropriateness before they are surfaced to members and providers. Refine the algorithms through clinical expertise and rigorous quality assurance.
- Polypharmacy and medication reconciliation: Validate AI-flagged polypharmacy cases (concurrent CNS-actives, high-dose opioids, duplicate therapy, long-term PPI, inappropriate combinations) and develop intervention recommendations.
- Site-of-care optimization: In partnership with the Chief Medical Officer, review candidates for infusion site of care navigation for clinical appropriateness and feasibility. Support our clinical navigators as they handle member engagement and logistic care coordination of these opportunities.
- Fulfillment alternative oversight: Review cash-pay and alternative channel recommendations for clinical appropriateness, particularly for specialty medications where supply chain and formulation differences matter.
- Clinical program design: Partner with the CMO to build clinical SOPs, escalation pathways, exception handling protocols, and quality metrics from scratch.
- Product feedback loop: Serve as a key clinical input into product development. When AI outputs are incorrect, you flag it and collaborate with product team to improve the algorithm. Where the AI system needs clinical guardrails, you help build them. When a workflow doesn’t match clinical reality, you help redesign it.
- Team support: Be the clinical subject matter expert for your peer navigators with less clinical training (RN, MA, etc) who will have questions and escalations for your review.
What You'll Own
Your team will be accountable for measurable clinical and financial outcomes. While exact targets will be set collaboratively as we learn, expect to own metrics such as:
- Prescriber acceptance rate: Percentage of recommended medication changes accepted by prescribers after your peer-to-peer outreach.
- Switch persistence: Percentage of completed switches that remain in place at 6 and 12 months — a measure of whether the clinical rationale holds and members stay on the new therapy.
- Formulary optimization conversion rate: Percentage of AI-identified opportunities that convert to completed switches after your clinical review and prescriber engagement.
- Polypharmacy intervention completion: Percentage of flagged polypharmacy cases that result in a documented clinical action (deprescribing, dose adjustment, monitoring plan, or clinical rationale for no change).
- Clinical review turnaround: Time from AI-generated recommendation to your clinical sign-off — speed matters for member engagement windows.
- Member satisfaction: How members rate their interactions with you and the products you help shape.
What We’re Looking For
Required:
- Doctor of Pharmacy (PharmD) with active pharmacist license in good standing, multiple state licensure is a plus; willingness to obtain licensure in additional states as our client geography expands (Tokaido reimburses fees and CE costs)
- Board certification: BCPS (Pharmacotherapy) or BCACP (Ambulatory Care).
- 5+ years of post-graduate clinical pharmacy experience in specialty pharmacy, ambulatory care, or comparable clinic or hospital-based settings; residency training is a plus. Experience limited to community pharmacy, MTM‑only roles, or PBM utilization management will not be considered qualifying.
- Comfort engaging prescribers on medication changes. Ideally you have led biosimilar substitutions, therapeutic interchanges, or deprescribing conversations with physicians. If not, you can demonstrate the clinical reasoning and communication skills to develop that competency rapidly.
- Depth in at least two therapeutic areas: rheumatology, gastroenterology, dermatology, neurology, endocrine, respiratory or cardiometabolic, with willingness to develop cross-coverage across our full clinical surface area.
- Hands-on experience with AI-assisted clinical workflows. You should be able to point to specific tools you have used or experimented with: clinical decision support, structured chart review, LLM-assisted documentation, or general-purpose tools like ChatGPT or Claude for clinical reasoning.
- Startup mentality — you thrive in ambiguity, can self-direct when processes don’t exist yet, and get energy from building something new rather than optimizing something established
Strongly Preferred:
- Experience building a clinical program from scratch (UM program, MTM service, specialty pharmacy clinical protocols, or similar)
- Experience at a digital health company and/or navigator
- Familiarity with PBM formulary structures, prior authorization processes, and specialty pharmacy distribution models
- Experience with claims-based clinical analytics (identifying opportunities from pharmacy and medical claims data)
- Background in utilization management or clinical program development at a health plan, PBM, or clinical services vendor
Why Tokaido
As Tokaido adds clients, this role grows into a clinical leadership position. You will help hire and manage additional pharmacists, build out a lean clinical governance structure (formulary review protocols, switching criteria, exception handling standards), and shape the clinical intelligence roadmap alongside the CMO and CTO. The next hire on your team will likely be a certified pharmacy technician (CPhT) to handle routine member outreach and formulary-related follow-up, extending your clinical reach without requiring you to be on every call.
Our Values
Momentum is everything · Pioneers, not passengers · It’s (not) complicated · Win-Win-Win · Build a legacy
Skills Required
- Doctor of Pharmacy (PharmD) with active pharmacist license in good standing; willingness to obtain additional state licensure as needed
- Board certification: BCPS (Pharmacotherapy) or BCACP (Ambulatory Care)
- 5+ years post-graduate clinical pharmacy experience in specialty pharmacy, ambulatory care, or comparable clinic or hospital-based settings
- Experience engaging prescribers on medication changes, including biosimilar substitutions, therapeutic interchanges, or deprescribing
- Depth in at least two therapeutic areas (rheumatology, gastroenterology, dermatology, neurology, endocrine, respiratory, cardiometabolic)
- Hands-on experience with AI-assisted clinical workflows and tools (clinical decision support, structured chart review, LLM-assisted documentation, ChatGPT/Claude)
- Startup mentality: comfortable with ambiguity and building processes from scratch
- Experience building a clinical program from scratch (UM program, MTM service, specialty pharmacy clinical protocols, or similar)
- Experience at a digital health company and/or navigator role
- Familiarity with PBM formulary structures, prior authorization processes, and specialty pharmacy distribution models
- Experience with claims-based clinical analytics
- Background in utilization management or clinical program development at a health plan, PBM, or clinical services vendor
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The Company
What We Do
Tokaido Health, Inc. is a US-based company that provides an AI-native medication steerage and navigation platform. The company specializes in AI-driven medication management solutions that connect patients with cost-effective medication options, utilizing behavioral economics to optimize medication spending and improve clinical outcomes. Its platform focuses on areas such as biosimilar substitution and infusion site-of-care steerage to enhance healthcare efficiency and affordability.
