Clinical Administrative Pharmacist - Remote TN

Prime Therapeutics; Salem (OR); Remote; USD 108,000 - 184,000; Full time

Job summary

Prime Therapeutics is hiring a Clinical Administrative Pharmacist - Remote TN to deliver clinical and regulatory analysis supporting operations and formulary management. You will work on testing scenarios, ensure regulatory compliance, and support data for drug utilization and claims adjudication.

The role requires PharmD or BS Pharmacy, a current pharmacist license, and 1 year of relevant experience, with eligibility to work in the United States without sponsorship.

Qualifications

• PharmD or BS in Pharmacy required.
• 1 year of work experience in clinical, retail, hospital, or managed care.
• Current Pharmacist license to practice in applicable state(s).
• Must be eligible to work in the United States without visa sponsorship.

Responsibilities

• Deliver clinical and regulatory analysis to support operations and programs.
• Develop and maintain project and benefit plan testing scenarios.
• Interpret requests and provide technical solutions.
• Conduct testing, plan creation, and user acceptance testing.
• Ensure compliance with federal, CMS, state, local, and pharmacy regulations.
• Develop and verify data for drug utilization and claims adjudication systems.
• Support formulary changes and participate in committees as needed.
• Perform root-cause analysis and resolve system issues.
• Other duties as assigned.

Skills

Clinical analysis

Regulatory compliance

Data interpretation

Team collaboration

Education

PharmD or BS Pharmacy

Tools

AS400

Lotus Notes

Excel

Word

Job description

Full time

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 experienceBoard 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 (https://www.primetherapeutics.com/benefits) and click on the "Benefits at a glance" button for more detail (https://www.primetherapeutics.com/benefits).

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

At Prime Therapeutics (Prime), we are a different kind of PBM. We’re reimagining pharmacy solutions to provide the care we would want for our loved ones. That purpose energizes our team and creates limitless opportunities to make a difference.

We know that people make all the difference. If you’re ready for a purpose-driven career and are passionate about simplifying health care, let’s build the future of pharmacy together.

Prime Therapeutics LLCis 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.

If you are an applicant with a disability and need a reasonable accommodation for any part of the employment process, please contact Human Resources at email [e-mail].