Clinical Pharmacist- REMOTE

Lensa; Raleigh (NC); Remote; USD 108,000 - 184,000; Full time

Job summary

An innovative company is seeking a Clinical Pharmacist to join their team remotely. This role involves analyzing clinical programs, ensuring compliance with regulations, and supporting quality assurance activities. You will work closely with various teams to develop testing scenarios and document processes, all while maintaining drug lists and ensuring accuracy in claims adjudication. If you're passionate about making a difference in healthcare and have a strong analytical background, this is the perfect opportunity for you to thrive in a dynamic environment.

Qualifications

• PharmD or BS in Pharmacy required.
• 1+ years in clinical, retail, or managed care settings.

Responsibilities

• Develop and maintain project testing scenarios.
• Ensure benefit plans comply with regulations.
• Conduct User Acceptance Testing for quality assurance.

Skills

Analytical Skills

Problem-Solving Skills

Teamwork

Process Efficiency Development

Education

Doctor of Pharmacy (PharmD)

Bachelor of Science in Pharmacy

Tools

Microsoft Excel

Microsoft Word

MediSpan

RxClaim

AS400

Lotus Notes

Job description

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Lensa is the leading career site for job seekers at every stage of their career. Our client, Prime Therapeutics, is seeking professionals. Apply via Lensa today!

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 - REMOTE

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 involves participating in internal, client-initiated, and regulatory projects, as well as supporting quality assurance and analytical activities related to benefit plans.

Responsibilities

1. 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.
2. Interpret project requests to determine feasibility, develop business requirements, and assist with developing technical solutions.
3. Document processes for execution and conduct User Acceptance Testing (UAT) for quality assurance.
4. Identify system problems, resolve setup issues, and escalate system defects with urgency to avoid member disruption.
5. Ensure benefit plans comply with all regulations including federal, CMS, state, local, and pharmacy laws.
6. Develop, maintain, and verify drug lists with claims adjudication systems to support benefit coverage decisions, therapy, quantity limits, and prior authorization programs.
7. Maintain point of service messages and concurrent Drug Utilization Review table settings, ensuring accuracy of claims adjudication through weekly MediSpan product file maintenance and quarterly P&T implementation decisions.
8. Perform other duties as assigned.

Education & Experience

• Doctor of Pharmacy (PharmD) or Bachelor of Science in Pharmacy.
• Current pharmacist license in good standing with the State Board of Pharmacy where the position is located.
• At least 1 year of experience in clinical, retail, hospital, or managed care settings.
• Must be eligible to work in the United States without a visa or residency sponsorship.

Additional Qualifications

• Strong analytical and problem-solving skills with attention to detail.
• Ability to manage multiple projects under pressure with strict timelines.
• Ability to develop process efficiencies.
• Teamwork skills.
• Proficiency in Microsoft Excel and Word.

Preferred Qualifications

• MediSpan or First Databank experience.
• Formulary Database management experience.
• Knowledge of AS400, queries, and Lotus Notes.
• RxClaim experience.

Physical Demands

• Flexible schedule including weekends, holidays, and peak season hours.
• Constant sitting, talking, hearing; frequent reaching; occasional standing, walking, stooping, kneeling, crouching.
• Lifting up to 10-25 pounds occasionally.
• Specific vision abilities required.

All employees must adhere to security responsibilities and comply with legal, regulatory, contractual, and internal policies.

Potential pay ranges from $108,000 to $184,000 based on experience and skills. For benefits details, visit our Benefits Page.

Prime Therapeutics is an equal opportunity employer that encourages diverse candidates to apply and considers all qualified applicants without discrimination.

If you need a reasonable accommodation during the application process, contact Human Resources at 1.866.469.1257 or email [e-mail].