Pharmacist, Clinical Services - Temp

Abarca Health LLC.; San Juan (PR); Hybrid; USD 90,000 - 120,000; Full time

Job summary

Abarca Health LLC. is seeking a Clinical Services Pharmacist to lead coverage determinations and clinical program development. You will use claims data and formulary information to craft evidence-based recommendations and partner with care teams to improve medication use and health outcomes.

In this hybrid role in Puerto Rico, you will contribute to CMS and Medicaid initiatives, participate in audits, and help implement policies that enhance patient care across beneficiary programs.

Qualifications

• 3+ years of experience in clinical operations, clinical programs or medication therapy management.
• Excellent oral and written communication.
• Flexibility to work in a hybrid model with on-site days at Puerto Rico location.
• Ability to operate within the required time zone and support on-call needs if applicable.

Responsibilities

• Evaluate coverage determinations and develop clinical programs to improve health outcomes.
• Perform comprehensive and targeted medication reviews to identify and resolve medication-related problems.
• Use prescription and claims data to inform clinical recommendations and formulary decisions.
• Collaborate with Health Educators and Case Managers to ensure MTM participants receive necessary information.
• Stay updated on drug therapies and management of chronic conditions to support programs.
• Collaborate with cross-functional teams to plan clinical projects and operationalize formularies.
• Support CMS Medicare STAR, Medicaid initiatives, and participate in audits and Pharmacy & Therapeutics Committee activities.
• Develop and document Clinical Policies and Procedures.

Skills

Clinical operations experience

Excellent communication

On-call availability

Hybrid work adaptability

Time zone coordination

PBM experience (nice to have)

Education

Doctoral Degree in Pharmacy

Job description

Description

Abarca is igniting a revolution in healthcare. We built our company on the belief that with smarter technology we are redefining pharmacy benefits, but this is just the beginning…

What you'll do

As our Clinical Services Pharmacist, will have an important role in the evaluation of coverage determination requests and in the development and execution of clinical programs designed with the major goal of improving health-related outcomes for our client’s beneficiaries. You’ll work in a few areas across the Clinical group with the goal of optimizing the use of medication, promoting health, wellness, and disease prevention among our clients’ beneficiaries through comprehensive and targeted medication reviews to identify, resolve, and prevent medication-related problems.

The fundamentals for the job…

• Perform comprehensive and targeted medication reviews to identify, resolve, and prevent medication-related problems and document the care delivered.
• Use prescription and medical claims data and client formulary information to provide clinical recommendations.
• Make recommendations regarding gaps in care, high risk medications, drug interactions, therapeutic and generic substitution, compliance, and adherence, among others.
• Collaborate with Health Educators and Case Managers to ensure MTM and other clinical programs participants receive all the necessary and relevant information.
• Maintain up to date knowledge advances in drug therapies and management of chronic conditions; leverage knowledge for supporting programs and associated teams.
• Constantly evaluate, analyze, and look for methods to streamline processes to ensure improved patient care, outcomes, and program quality.
• Collaborate with cross-functional teams to plan and execute clinical projects, operationalize formularies and medication lists, and deliver the highest quality of service to clients and partners.
• Support CMS Medicare STAR initiatives, Medicaid’s Health Care Improvement Program, and other clinical programs. Participate in government and internal audits, and in the Pharmacy & Therapeutics Committee, preparing presentations and clinical recommendations.
• Develop and document Clinical Policies and Procedures.
• Evaluate coverage determination requests, ensuring that all coverage determinations and appeal responses are clinically appropriate and compliant.
• Assist in providing clinical support, including drug information to the PA Customer Service Teams, to ensure appropriate clinical decisions are made for beneficiaries, before, during, and after point of sale.
• Ensure CMS’ and URAC Compliance in all clinical processes executed.

Requirements

What we expect of you

• Doctoral Degree in Pharmacy is required.
• Current and Active Pharmacy License from Puerto Rico is required.
• 3+ years of experience working with clinical operations, clinical programs or medication therapy management.
• Excellent oral and written communication skills.
• We are proud to offer a flexible hybrid work model which will require certain on-site work-days (Puerto Rico Location Only)
• This position requires availability to work in a specified time zone or working schedule, accommodating the business needs of our clients and team members.
• This position may require availability for on-call hours, including evenings, weekends, and holidays, to promptly address emergent issues or provide necessary support as dictated by operational demands (if applicable).

Nice to haves...

• Experience working in pharmacy benefit management (PBM) industry.

Physical Requirements

• Must be able to access and navigate each department at the organization’s facilities.
• Sedentary work that primarily involves sitting/standing.

At Abarca we value and celebrate diversity. Diversity, equity, inclusion, and belonging are guiding principles of Abarca and ensure Abarca’s workforce reflects the communities it serves. We are proud to provide equal employment opportunities to all employees and applicants for employment and prohibit discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, medical condition, genetic information, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.

Abarca Health LLC is an equal employment opportunity employer and participates in E-Verify. Abarca Health LLC does not sponsor employment visas at this time.

The above description is not intended to limit the scope of the job or to exclude other duties not mentioned. It is not a final set of specifications for the position. It’s simply meant to give readers an idea of what the role entails.