Clinical Specialist Pharmacist Sr- REMOTE

At Prime Therapeutics (Prime), we are a different kind of PBM, with a purpose beyond profits and a unique ability to connect care for those we serve. Looking for a purpose-driven career? Come build the future of pharmacy with us.

Job Posting Title

Clinical Specialist Pharmacist Sr- REMOTE

Job Description

The Senior Clinical Specialist Pharmacist is responsible for the distribution of clinical drug information, review of prior authorization and other Utilization Management (UM) requests, claim adjudication support, addressing providers and stakeholders concerns, and facilitating efforts in the development and implementation of pharmacy solutions. This role will provide clinical research, analysis, and subject matter support to External Affairs divisions and correlating projects. In addition, this position works closely with internal staff in the refinement of the clinical program, providing consultation on pharmacy issues to clinical operations representatives and advancing the successful implementation of these programs for customer organizations.

Responsibilities

• Respond to provider inquiries and/or concerns and assist in resolving escalated and/or complex provider service issues
• Collaborate with clients, patients, providers, and healthcare professionals to proactively identify and resolve access-related barriers; manage a wide range of complex issues, applying clinical insight and thinking to uncover and address underlying challenges for timely and effective resolution
• Participate in the recommendation/implementation of strategies to address access to therapy and claim adjudication goals
• Contribute to program improvements by using continuous quality improvement processes, by being proactive in identifying improvement opportunities and by contributing on-going consultation and collaboration with product leaders
• Serve as a clinical subject matter expert and mentor; support Clinical Staff Pharmacists and lead Education and Outreach efforts through provider engagement, office hours, and development or review of educational resources
• Evaluate requests for prior authorization (PA) or other utilization management (UM) programs, including quantity limits, step therapy, formulary exception and tier exception; includes consideration of the denial language and appropriateness of the decision as it pertains to the clinical content of the case and the client's pre-approved criteria
• Uphold clinical integrity of pharmaceutical solutions by staying up-to-date on medication information, collaborating with and providing pharmacy expertise within the organization
• Other duties as assigned

Minimum Qualifications

• PharmD or Bachelor of Science Pharmacy degree

• 3 years work experience clinical, retail, hospital, or managed care
• Current Pharmacist license to practice in the applicable state(s)

Must be eligible to work in the United States without the need for work visa or residency sponsorship

Additional Qualifications

• Demonstrated expertise in managed care, clinical pharmacy, drug products, and claims adjudication, including coordination of benefits
• Proven ability to work independently and collaboratively within multidisciplinary teams, escalating issues and identifying barriers when needed
• Strong analytical, research, and implementation skills that translate into practical, results-driven recommendations
• Excellent interpersonal and communication skills, both verbal and written, with proficiency in Microsoft Office tools
• Skilled in problem-solving and navigating complex environments with professionalism and adaptability

Preferred Qualifications

• 1 year of experience within Prime Clinical Review
• Managed care experience

Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their job, and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures

Every employee must be able to perform the essential functions of the job and, if requested, reasonable accommodations will be made to enable employees with disabilities to perform the essential functions, absent undue hardship. In addition, Prime retains the right to change or assign other duties to this job.

Potential pay for this position ranges from $124,000.00 - $211,000.00 based on experience and skills.

To review our Benefits, Incentives and Additional Compensation, visit our Benefits Page and click on the "Benefits at a glance" button for more detail (

Prime Therapeutics LLC is proud to be an equal opportunity and affirmative action employer. We encourage diverse candidates to apply, and all qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sex (including pregnancy), national origin, disability, age, veteran status, or any other legally protected class under federal, state, or local law.

We welcome people of different backgrounds, experiences, abilities, and perspectives including qualified applicants with arrest and conviction records and any qualified applicants requiring reasonable accommodations in accordance with the law.

Prime Therapeutics LLC is a Tobacco-Free Workplace employer.

Positions will be posted for a minimum of five consecutive workdays.