Remote Clinical Pharmacist - Formulary & Compliance

Prime Therapeutics

Nashville (TN)

Remote

USD 108,000 - 184,000

Full time

5 days ago

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Job summary

Prime Therapeutics is seeking a Clinical Administrative Pharmacist to deliver clinical and regulatory analysis supporting operations, formulary management, and benefit plan publications. This remote TN role collaborates with internal and client teams to ensure compliance and effective drug utilization.

Responsibilities include testing, data development for drug utilization and claims adjudication, and support for Drug Utilization Review messages.

Qualifications

1 year of work experience in clinical, retail, hospital, or managed care.
Current Pharmacist license to practice in the applicable state(s).
Eligible to work in the United States without visa sponsorship.
Knowledge of AS400, queries, and Lotus Notes.
Ability to analyze and ensure regulatory compliance and quality assurance.

Responsibilities

Develop and maintain project and benefit plan testing scenarios, including utilization management.
Interpret requests, document requirements, and provide technical solutions.
Conduct testing: test plan creation, execution, and user acceptance testing.
Identify and resolve system issues; perform root-cause analysis.
Ensure benefit plans comply with federal, CMS, state, and local regulations.
Develop, maintain, and verify data for drug utilization and claims adjudication.
Support Drug Utilization Review messages and adjudication workflows.
Collaborate with leaders to implement formulary changes and advise committees.
Other duties as assigned.