Clinical Pharmacist

Our work matters. We help people get the medicine they need to feel better and live well. We do not lose sight of that. It fuels our passion and drives every decision we make.

Job Posting Title

Clinical Pharmacist
**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

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

Minimum Physical Job Requirements
- Ability to work a flexible schedule including weekends, holidays, additional hours during peak season, on-call, and shifts outside of Prime’s core business hours of 9:00 a.m. to 3:00 p.m.
- Constantly required to sit, use hands to handle or feel, talk and hear
- Frequently required to reach with hands and arms
- Occasionally required to stand, walk and stoop, kneel, and crouch
- Occasionally required to lift and/or move up to 10 pounds and occasionally lift and/or move up to 25 pounds
- Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus

Reporting Structure
- Reports to Supervisor, Manager or Director in the Clinical Review, PBM Operations, Pharm & Network Services or Clinical Operations department

Potential pay for this position ranges from $104,700.00 - $167,300.00 based on location, 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.