Regulatory Clinical Pharmacist – Health Plan Compliance

Medica; Hopkins (MN); On-site; USD 113,000 - 194,000; Full time

Job summary

Medica is seeking a Clinical Pharmacist - Regulatory to support the Pharmacy department's regulatory compliance across Medicare, Medicaid, and Commercial lines. This office-based role oversees regulatory submissions, NCQA initiatives, and audits, coordinating with internal teams and external regulators.

The position requires collaboration across departments to ensure compliant pharmacy services. Office role with onsite work required, 3 days per week.

Qualifications

• Bachelor of Science in Pharmacy or PharmD required.
• 5+ years of experience in health plan pharmacy, PBM clinical management, or related clinical leadership role beyond degree.
• Active Pharmacist license required.

Responsibilities

• Regulatory Oversight: review regulatory guidance and ensure compliance.
• Delegate Oversight: oversee clinical reviews and services delegated to PBM/medical drug vendor.
• Clinical Case Reviews: perform internal reviews for Medicare/Medicaid/Commercial cases.
• Support operational teams with member, provider, and pharmacy inquiries.

Education

Bachelor of Science in Pharmacy or PharmD

Job description

Medica is seeking a Clinical Pharmacist - Regulatory to support the Pharmacy department's regulatory compliance across Medicare, Medicaid, and Commercial lines. This office-based role oversees regulatory submissions, NCQA initiatives, and audits, coordinating with internal teams and external regulators.

The position requires collaboration across departments to ensure compliant pharmacy services. Office role with onsite work required, 3 days per week.