Pharmacist, Clinical Utilization Management - Archimedes

Navitus Health Solutions / Lumicera Health Services; United States; Remote; USD 100,000 - 170,000; Full time

Benefits offered by this job

Health, Dental, and Vision insurance

20 days paid time off

4 weeks paid parental leave

401K company match up to 5%

Adoption Assistance Program

Flexible Spending Account

Educational Assistance Plan

Professional Membership assistance

Referral Bonus up to $750

Job summary

Archimedes is seeking a Pharmacist, Clinical Utilization Management to join our team remotely. You will serve as the clinical expert for specialty medications across both pharmacy and medical benefits, communicating with physicians, nurses, pharmacists, and members on high-cost cases, dose management, and cost controls.

The role includes peer-to-peer consultations, external clinical outreach, prior authorization, and policy development.

Qualifications

• Clinical communication with physicians, nurses, pharmacists.
• Experience with prior authorization processes and utilization management.
• Ability to analyze clinical data and cost implications.

Responsibilities

• Develop and deliver clinical messages to physicians, members, clients, and consultants.
• Manage prior authorization, high-cost cases, claims editing and policy development.
• Perform outreach to prescribers to obtain information and support timely case resolution.
• Communicate with prescribers and stakeholders via phone, email, or fax.

Skills

Clinical communication

Team collaboration

Prior authorization

Education

Pharmacist degree / PharmD

Unrestricted pharmacist license

Board Certification preferred

Tools

Microsoft Excel

PowerPoint

Word

Job description

Company

Archimedes

About Us

Archimedes - Transforming the Specialty Drug Benefit - Archimedes is the industry leader in specialty drug management solutions. Founded with the goal of transforming the PBM industry to provide the necessary ingredients for the sustainability of the prescription drug benefit - alignment, value and transparency - Archimedes achieves superior results for clients by eliminating tightly held PBM conflicts of interest including drug spread, rebate retention and pharmacy ownership and delivering the most rigorous clinical management at the lowest net cost.

We are committed to providing equal employment opportunity to all applicants and employees and comply with all applicable nondiscrimination regulations, including those related to protected veterans and individuals with disabilities. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, or handicap.

Pay Range

USD $0.00 - USD $0.00 /Yr.

STAR Bonus % (At Risk Maximum)

0.00 - Ineligible

Work Schedule Description (e.g. M-F 8am to 5pm)

M-F 8am to 5pm

Overview

Archimedes is seeking a Pharmacist, Clinical Utilization Managementto join our team!

The Pharmacist, Clinical Utilization Management is the clinical expert for all specialty medications across both the pharmacy and the medical benefit. This role will communicate with physicians, nurses, pharmacists, and members related to high-cost case concerns, dose management, genetic testing, therapeutic substitutions, and cost management related to specialty drugs.

The Pharmacist, Clinical Utilization Management will serve as a clinical subject matter expert and conduct peer to peer consultations with physicians. This position is divided into two areas: external clinical outreach activities related to high-cost case management and prior authorization of specialty medications, across pharmacy and medical benefits and specialty and traditional drugs. In addition, this role will have the opportunity to evaluate the data to identify actionable opportunities for specialty management and create clinical policies.

Responsibilities

How do I make an impact on my team?

• Develop and deliver clinical messages to physicians, members, clients, and consultants.
• Manage prior authorization, high-cost cases, claims editing and clinical policy development.
• Conduct prior authorization outreach to prescribers to obtain clinical information, clarify requests, and support timely case resolution.
• Communicate with prescribers and other clinical stakeholders by phone, email, or fax regarding prior authorization requests, clinical documentation, and benefit requirements.
• Engage in evidence-based clinical conversations with prescribers to explain utilization management criteria, coverage determinations, and appropriate therapeutic alternatives.
• Serve as a clinical resource for member-facing teammates, providing prior authorization guidance, clinical context, and support for member inquiries.
• Communicate directly with members on an as-needed basis to address prior authorization questions and support understanding of clinical or coverage-related information.
• Clinical program development including both medical and pharmacy benefit management.
• Define, document, and deliver results for plan sponsors.
• Evaluate and summarize clinical literature as well as financial implications related to medication management options.
• Present deep clinical and cost effectiveness information as subject matter expert.
• Other duties as assigned.

Qualifications

What our team expects from you?

• Bachelor's degree in Pharmacy or PharmD degree required.
• Current, unrestricted licensure as a Registered Pharmacist in the state of residence, or the ability to gain reciprocity within 4 months, may be required based on state of residence laws or client contracts. Other State Pharmacy Licenses may be required as business need dictates. Board of Pharmacy Certification preferred for Pharmacotherapy, Ambulatory Care or Oncology Care.
• Pharmacy experience in retail, hospital, managed care, or other pharmacy-related setting preferred.
• Experience and knowledge in Pharmacy and Medical specialty benefits preferred.
• Proficiency in Microsoft Excel, PowerPoint, and Word required.
• Experience with physician-facing clinical communication preferred.
• Participate in, adhere to, and support compliance program objectives.
• The ability to consistently interact cooperatively and respectfully with other employees.

What can you expect from Archimedes?

• Top of the industry benefits for Health, Dental, and Vision insurance
• 20 days paid time off
• 4 weeks paid parental leave
• 9 paid holidays401K company match of up to 5% - No vesting requirement
• Adoption Assistance Program
• Flexible Spending Account
• Educational Assistance Plan and Professional Membership assistance
• Referral Bonus Program - up to $750!

#LI-Remote

Location : Address

Remote

Location : Country

US