Clinical Administrative Pharmacist - Remote TN

Prime Therapeutics; Nashville (TN); Remote; USD 108,000 - 184,000; Full time

Job summary

Prime Therapeutics is seeking a Clinical Administrative Pharmacist to deliver clinical and regulatory analysis supporting operations, formulary management, and benefit plan publications. This remote TN role collaborates with internal and client teams to ensure compliance and effective drug utilization.

Responsibilities include testing, data development for drug utilization and claims adjudication, and support for Drug Utilization Review messages.

Qualifications

• 1 year of work experience in clinical, retail, hospital, or managed care.
• Current Pharmacist license to practice in the applicable state(s).
• Eligible to work in the United States without visa sponsorship.
• Knowledge of AS400, queries, and Lotus Notes.
• Ability to analyze and ensure regulatory compliance and quality assurance.

Responsibilities

• Develop and maintain project and benefit plan testing scenarios, including utilization management.
• Interpret requests, document requirements, and provide technical solutions.
• Conduct testing: test plan creation, execution, and user acceptance testing.
• Identify and resolve system issues; perform root-cause analysis.
• Ensure benefit plans comply with federal, CMS, state, and local regulations.
• Develop, maintain, and verify data for drug utilization and claims adjudication.
• Support Drug Utilization Review messages and adjudication workflows.
• Collaborate with leaders to implement formulary changes and advise committees.
• Other duties as assigned.

Skills

AS400

Queries

Lotus Notes

Education

Doctor of Pharmacy (PharmD) or Bachelor of Science Pharmacy Degree

Board of Pharmacy Specialties (BPS) certification / residency / fellowship

Tools

Excel

Word

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.

Clinical Administrative Pharmacist - Remote TN

Job Description

The Clinical Pharmacist is responsible for delivering clinical and regulatory analysis activities that support operations and the implementation of clinical and regulated programs, including coverage lists for benefit plans, formulary management, and publications. This role participates in internal and client-initiated projects, conducting analysis and ensuring compliance with quality assurance standards. This position provides direct support for benefit plan functions and contributes to the execution of regulatory requirements and pharmacy-related initiatives.

Responsibilities

• Partner with internal stakeholders and clients to develop and maintain project and benefit plan testing scenarios, including utilization management and specialty offerings
• Interpret project requests to determine feasibility, document requirements, and provide technical solutions
• Conduct testing, including test plan creation, test execution, and User Acceptance Testing for quality assurance
• Identify and resolve system issues, perform root-cause analysis, and elevate problems to avoid service disruption
• Ensure benefit plans remain in compliance with all regulatory requirements (federal, CMS, state, local, and pharmacy)
• Develop, maintain, and verify data for drug utilization and claims adjudication systems to support evidence-based benefit coverage decisions
• Support concurrent Drug Utilization Review service messages, table settings, testing, and adjudication workflows to ensure accuracy and compliance with established protocols and implementation decisions
• Collaborate with leaders to implement client-requested formulary changes and provide subject-matter expertise to internal and external committees
• Other duties as assigned

Minimum Qualifications

• Doctor of Pharmacy (PharmD) or Bachelor of Science Pharmacy Degree
• 1 year of work experience in 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

• Knowledge of AS400, queries, and Lotus Notes
• Strong analytical and problem-solving skills with attention to detail and quality
• Ability to manage multiple projects simultaneously under pressure with strict timelines
• Skilled in developing and improving process efficiencies
• Strong collaboration skills and ability to work in a team-oriented environment
• Proficiency with Microsoft Excel and Word

Preferred Qualifications

• MediSpan or First Databank experience
• Formulary Database/Workplace management tool experience
• Claim adjudication system experience
• Board of Pharmacy Specialties (BPS) certification, pharmacy residency, or fellowship

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 $108,000.00 - $184,000.00 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 (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.