Director, Specialty Clinical Solutions/Medical pharmacy exp required- REMOTE

Prime Therapeutics; Madison (WI); Remote; USD 143,000 - 243,000; Full time

Job summary

Prime Therapeutics seeks a Director, Specialty Clinical Solutions to lead medical pharmacy strategy and clinical services across client programs. This remote role drives clinical excellence, program design, and client engagement.

The position requires a PharmD or BS in Pharmacy with 7+ years in medical pharmacy or Health Plan settings, plus an active pharmacist license in the United States. You will collaborate with internal teams and clients to deliver value and outcomes.

Qualifications

• Doctor of Pharmacy (PharmD) or Bachelor of Science Pharmacy degree.
• 7 years of work experience in medical pharmacy or at Health Plan with multiple lines of business
• 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

Responsibilities

• Serve as the lead clinical consultant and SME for assigned clients.
• Partner with account management and business development to support client retention, growth opportunities, financial analyses, and new business initiatives.
• Develop and advance innovative medical pharmacy strategies through data-driven insights, clinical solution design, and program enhancements.
• Evaluate emerging therapies, market trends, and medical benefit drug management opportunities to improve clinical outcomes, affordability, and client value.
• Oversee client-facing medical pharmacy programs and utilization management solutions, including fee schedule management, prior authorization, post-service claim edits, and related programs.
• Identify opportunities to expand existing programs and recommend new solutions that address evolving client and market needs.
• Collaborate with cross-functional teams to evaluate program performance, develop business rules, deliver actionable insights, and drive continuous improvement through enhanced reporting and operational efficiencies.
• Lead the development of client-facing clinical materials, strategic presentations, thought leadership content, and industry-facing publications.
• Represent the organization as a clinical expert and mentor through industry engagement, enterprise initiatives, conference presentations, and guidance to peers and cross-functional partners.
• Other duties as assigned

Skills

Interpersonal skills

Communication skills

Presentation skills

Verbal communication

Written communication

Organizational skills

Tracking & follow-up

Education

PharmD / BS Pharmacy

Job description

Home

Full time

R-17419

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.

Job Posting Title

Director, Specialty Clinical Solutions/Medical pharmacy exp required- REMOTE

Job Description

The Specialty Clinical Solutions Director Senior is responsible for overseeing the clinical services and strategies within the Medical Pharmacy & Specialty programs delivered to customers including clinical and utilization management, analysis, innovation, financial management, regulatory & quality compliance, and contractual obligations.

Responsibilities

• Serve as the lead clinical consultant and subject matter expert for assigned clients, providing strategic guidance on medical pharmacy and specialty programs
• Partner with account management and business development teams to support client retention, growth opportunities, financial analyses, and new business initiatives
• Develop and advance innovative medical pharmacy strategies through data-driven insights, clinical solution design, and program enhancements
• Evaluate emerging therapies, market trends, and medical benefit drug management opportunities to improve clinical outcomes, affordability, and client value
• Oversee client-facing medical pharmacy programs and utilization management solutions, including fee schedule management, prior authorization, post-service claim edits, and related programs
• Identify opportunities to expand existing programs and recommend new solutions that address evolving client and market needs
• Colloborate with cross-functional teams to evaluate program performance, develop business rules, deliver actionable insights, and drive continuous improvement through enhanced reporting and operational efficiencies
• Lead the development of client-facing clinical materials, strategic presentations, thought leadership content, and industry-facing publications
• Represent the organization as a clinical expert and mentor through industry engagement, enterprise initiatives, conference presentations, and guidance to peers and cross-functional partners
• Other duties as assigned

Minimum Qualifications

• Doctor of Pharmacy (PharmD) or Bachelor of Science Pharmacy degree
• 7 years of work experience in medical pharmacy or at Health Plan with multiple lines of business
• 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

• Strong interpersonal & communication, consultation, organizational, tracking and follow-up skills
• Ability to research, obtain, coordinate, and integrate feedback from diverse operational groups
• Excellent verbal and written communication skills
• Strong presentation skills who exude high confidence in project output and production

Preferred Qualifications

• Medical Pharmacy management, strategy & data interpretation experience at a health plan
• Health plan experience managing drugs on both the Pharmacy and Medical benefit across all lines of business

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 $143,000.00 - $243,000.00 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).

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.

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].