Sr. Clinical Pharmacist- REMOTE

📋 Description

• • As a Sr. Clinical Pharmacist at Prime Therapeutics LLC, you will play a pivotal role in shaping the future of pharmacy benefits and ensuring the seamless execution of clinical and regulatory programs. This remote position offers a unique opportunity to contribute to a purpose-driven organization that prioritizes connecting care for its members.
• • Your primary responsibility will involve the meticulous clinical and regulatory analysis required for the implementation of complex clinical and regulated programs, including the development and maintenance of coverage lists that directly support client benefits. This is a critical function that ensures our members receive the appropriate and compliant pharmaceutical care.
• • You will be an integral part of various projects, collaborating with internal teams, responding to client-initiated requests, and ensuring adherence to all relevant regulatory mandates. Your analytical prowess will be key in navigating the intricacies of benefit plans and their operationalization.
• • A significant aspect of your role will be to partner closely with the Quality Audit team and other relevant stakeholders. Together, you will develop and maintain robust project and benefit plan testing scenarios. These scenarios will cover a wide range of critical areas, including utilization management, specialty drug programs, and new client offerings, ensuring accuracy and effectiveness.
• • You will be tasked with interpreting complex project requests, assessing their feasibility, and translating them into clear, actionable business requirements. Furthermore, you will contribute to the development of effective technical solutions that support these requirements, bridging the gap between clinical needs and system capabilities.
• • Documenting processes for execution is a crucial part of maintaining operational excellence. You will be responsible for creating and maintaining clear, concise process documentation. Additionally, you will conduct thorough User Acceptance Testing (UAT) to guarantee the quality and accuracy of implemented solutions before they go live.
• • Proactive identification and resolution of system problems are paramount. You will be expected to identify system issues, resolve set-up challenges, and escalate system defects with a sense of urgency. This proactive approach is vital to prevent any disruption to member services and ensure a smooth user experience.
• • Ensuring that all benefit plans strictly comply with federal, CMS, state, local, and pharmacy regulations is a non-negotiable aspect of this role. Your expertise will be critical in maintaining this compliance, safeguarding both the company and its members.
• • You will develop, maintain, and verify drug lists within our claims adjudication systems. This ensures that benefit coverage decisions, contingent therapy programs, quantity limits, and prior authorization processes are accurately reflected and function as intended.
• • The role also involves developing and maintaining point-of-service messages and concurrent Drug Utilization Review (DUR) table settings. You will be responsible for ensuring the accuracy of claims adjudication through diligent weekly MediSpan product file maintenance and the quarterly implementation of P&T (Pharmacy and Therapeutics) decisions.
• • This position offers the opportunity to contribute to process improvements and develop efficiencies within the team and across departments. Your insights and recommendations will be valued in optimizing our workflows.
• • You will be expected to manage multiple projects simultaneously, often under pressure and with strict deadlines, demonstrating strong organizational and time management skills.
• • Collaboration is key. You will work effectively within a team environment, sharing knowledge and supporting colleagues to achieve collective goals.
• • This is a remote position, offering flexibility and the opportunity to work from home while making a significant impact on the healthcare landscape.