Job Description
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
Sr. Clinical Pharmacist- REMOTE
Job Description
The Clinical Pharmacist is responsible for the clinical and regulatory analysis activities required for the implementation of clinical and regulated programs, including coverage lists in support of client benefits. This position is responsible for participating in internal, client-initiated and regulatory projects. This position is also responsible for supporting quality assurance needs and analytical activities related to benefit plans.
Responsibilities
Partner with Quality Audit team and/or other roles to develop and maintain project and benefit plan testing scenarios including utilization management, specialty and new client offerings
Interpret project requests to determine feasibility, develop business requirements and assist with developing technical solutions
Document process for execution and conduct User Acceptance Testing (UAT) for quality assurance
Identify system problems, resolve set-up issues and/or escalate system defects with a sense of urgency to avoid member disruption
Ensure benefit plans are in compliance with all regulations including federal, CMS, state, local and pharmacy
Develop, maintain and verify drug lists with claims adjudication systems to support benefit coverage decisions and contingent therapy, quantity limits, and prior authorization programs
Develop and maintain point of service messages and concurrent Drug Utilization Review table settings, and ensure accuracy of claims adjudication through weekly MediSpan product file maintenance and quarterly P&T implementation decisions
Other duties as assigned
Minimum Qualifications
Doctor of Pharmacy (PharmD) or Bachelor of Science Pharmacy Degree
Current pharmacist license in good standing with the State Board of Pharmacy in the State where the position is located
1 year of work experience in clinical, retail, hospital, or managed care
Must be eligible to work in the United States without need for work visa or residency sponsorship
Must be eligible to work in the United States without the need for work visa or residency sponsorship
Additional Qualifications
Strong analytical and problem-solving skills with attention to detail and quality
Ability to work on multiple projects simultaneously under pressure with strict timelines
Ability to develop process efficiencies
Ability to work well in team environment
Microsoft Excel and Word proficiency
Preferred Qualifications
MediSpan or First Databank experience
Formulary Database management experience
Knowledge of AS400, queries, and Lotus Notes
RxClaim 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 (https://www.primetherapeutics.com/benefits).
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.