Clinical Pharmacist (Pulse PBM)

Revive; Victor (MT); Sur place; USD 120 000 - 150 000; Plein temps

Résumé du poste

Revive Health seeks a Clinical Pharmacist (Pulse PBM) to serve as the clinical voice for Pulse PBM, collaborating with plan sponsors, brokers, and Revive leadership to design and manage pharmacy benefits that reduce net cost and improve member outcomes.

You will review claims in real time, suggest therapeutic interchanges, run cost containment programs, and produce client reporting while communicating with members, prescribers, and clients, including quarterly business reviews.

Qualifications

• PharmD from ACPE-accredited college required.
• Active, unrestricted pharmacist license; multi-state license as needed.
• Minimum 1 year pharmacist experience in PBM/managed care or clinical setting; residency or board cert is a plus.
• Knowledge of formulary management, utilization management, prior authorization, and specialty pharmacy.
• Understanding PBM economics, cost containment programs (340B, copay maximizer, patient assistance).
• Strong analytical skills with claims data; experience with reporting/BI tools a plus.
• Excellent written and verbal communication; able to present to clients/brokers/executives.

Responsabilités

• Serve as the clinical lead on new client implementations, guiding design decisions.
• Translate client decisions into clinical edits, prior authorization criteria, step therapy, and quantity limits.
• Analyze prior-PBM claims and formulary data to assess disruption and recommend transition strategies.
• Monitor real-time pharmacy claims to identify high-cost/unsafe patterns and savings opportunities.
• Recommend therapeutic interchanges and biosimilars to lower net costs while maintaining outcomes.
• Prepare client reports and participate in quarterly business reviews with clients and brokers.
• Communicate with plan sponsors, brokers, TPAs, and members about therapy changes and enrollment.

Connaissances

Analytical skills

Communication skills

Advanced Excel

BI / reporting tools

Formation

Doctor of Pharmacy (PharmD)

Residency (PGY1) or board certification (plus)

Outils

Excel

BI tools

Description du poste

All Jobs > Clinical Pharmacist (Pulse PBM)

Revive is a dynamic and innovative organization specializing in healthcare delivery and technology. We pride ourselves on delivering exceptional products/services and building strong, long-lasting relationships with our valued clients.

The Clinical Pharmacist is the clinical voice of Pulse PBM, Revive Health's pharmacy benefit management business. This role partners with plan sponsors, brokers, and Revive pharmacy leadership to design, implement, and manage pharmacy benefits that deliver the lowest net cost while protecting and improving member outcomes. The Clinical Pharmacist reviews claims in real time, recommends therapeutic interchanges and other clinical savings opportunities, runs Pulse's cost containment programs, produces client reporting, and is part of the team that communicates directly with members, prescribers, and clients, including at quarterly business reviews.

Duties:

• Serve as the clinical lead on new client implementations, guiding plan sponsors and brokers through benefit design decisions such as formulary selection, utilization management, preventive coverage, and clinical program options.
• Review completed benefit design questionnaires and translate client decisions into clinical edits, prior authorization criteria, step therapy, and quantity limits in the claims system.
• Analyze prior-PBM claims and formulary data to assess member disruption, and recommend transition-of-care strategies before go-live.

Real-Time Claims Review & Clinical Optimization

• Monitor pharmacy claims in real time to identify high-cost claims, inappropriate utilization, safety concerns, and savings opportunities.
• Recommend therapeutic interchanges, generic and biosimilar alternatives, and other lower-net-cost options that maintain or improve clinical outcomes, and coordinate with prescribers and members to put changes in place.
• Analyze clinical reviews for prior authorizations, formulary exceptions, and coverage determinations according to plan criteria and render opinions or change recommendations.
• Conduct prospective, concurrent, and retrospective drug utilization review, and identify adherence and safety interventions such as opioid safety.

Cost Containment Programs

• Manage and execute Pulse cost-containment programs, including, but not limited to, international pharmacy, 340B, and manufacturer patient assistance programs.
• Identify eligible members and medications, coordinate enrollment, and track program savings and member impact.
• Ensure programs operate in line with plan documents, applicable federal and state law, and manufacturer program terms.

Reporting & Analytics

• Generate clinical and financial reports for clients and internal leadership, covering utilization trends, cost drivers, specialty spend, program savings, and clinical outcomes.
• Analyze claims data to project trend and quantify the impact of recommended benefit or formulary changes.
• Prepare clinical content for and participate in quarterly business reviews with clients and brokers.

Client & Member Communication

• Act as a clinical point of contact for plan sponsors, brokers, TPAs, and members, responding to clinical and coverage questions promptly and professionally.
• Communicate with members and prescribers about therapy changes, program enrollment, and coverage decisions in clear, plain language.
• Draft member and client communications such as formulary change notices and program materials.
• Work closely with Revive pharmacy executives on clinical strategy, formulary management, pricing, and new program development.
• Partner with account management, operations, and the claims processor to resolve issues and improve workflows.
• Stay current on new drug approvals, the drug pipeline, guideline changes, and market events such as biosimilar launches and patent expirations, and advise on their impact to clients.

Quality Assurance & Compliance

• Maintain accurate documentation of clinical reviews, interventions, and program activity.
• Ensure work complies with HIPAA, ERISA, the ACA, state pharmacy regulations, and internal policies.

Requirements

• Doctor of Pharmacy (PharmD) from an ACPE-accredited college of pharmacy.
• Active, unrestricted pharmacist license in good standing, with the ability to obtain additional state licenses as required.
• Minimum of 1 year of pharmacist experience in a PBM, managed care, health plan, or clinical pharmacy setting; managed care residency (PGY1) or board certification is a plus.
• Working knowledge of formulary management, utilization management, prior authorization criteria, and specialty pharmacy.
• Understanding of PBM economics (net cost, rebates, pricing, and pass-through models) and cost containment programs such as copay maximizer, 340B, and patient assistance programs.
• Strong analytical skills, including working with claims data and advanced Excel; experience with reporting or BI tools is a plus.
• Excellent written and verbal communication skills, with the ability to present to clients, brokers, and executives.
• Attention to detail and the ability to manage multiple clients, deadlines, and priorities in a fast-paced environment.