Senior Clinical Advisor, Pharmacy Policy & PA Ops

Rxadvance Corporation; Southborough (MA); On-site; USD 125,000 - 160,000; Full time

Job summary

RxAdvance Corporation seeks a Senior Clinical Advisor in Southborough, MA to leverage pharmacy acumen and payer knowledge for PA reviews, policy development, and analytics within Pharmacy Operations. The role involves collaborating with pharmacists and technicians to support PA processes and quality programs.

The ideal candidate has PharmD, PBM experience, and strong analytical and communication skills, with a focus on regulatory compliance and patient outcomes.

Qualifications

• Doctor of Pharmacy (PharmD) degree from an ACPE accredited college is required.
• Managed Care or Clinical Residency program residency highly preferred.
• 3–5 years of recent experience as a senior/lead pharmacist preferably in a PBM or health plan setting.
• Experience with Medicare Part D highly preferred.
• Must have a regard for confidential data and adherence to corporate compliance policy.
• Expert knowledge of the principles and practices of pharmaceutical science, a working knowledge of managed care and policy development as well as working knowledge of state and federal controlled substances and related laws, rules, and regulations.
• Experience using clinical resources, e.g., Micromedex, Lexicomp, Clinical Pharmacology.
• Registered and in good standing with the Board of Registration in Pharmacy.

Responsibilities

• Works with leadership on special projects to unlock capacity and improve efficiency.
• Translates client product requirements into technical design specifications and data flow for development, coding, and configuration.
• Coordinates activities as part of Formulary Development and Maintenance and recommends performance improvements.
• Conducts and evaluates research for utilization management strategies.
• Performs clinical reviews of PA, Step Therapy, Quantity Limit, and other pharmacy utilization requests.
• Performs coverage determinations and appeals according to guidelines and regulations.
• Responds to PA guideline coding and rationale questions.
• Represents RxAdvance in client meetings and with external entities.
• Identifies opportunities for continuous quality and efficiency improvements.
• Provides support for audits and surveys.

Skills

Clinical review

Initiative/Judgment

Analytical skills

Communication skills

Self-motivation

Prioritization

Education

PharmD

Residency preferred

Tools

Micromedex

Lexicomp

Clinical Pharmacology

Job description

RxAdvance Corporation seeks a Senior Clinical Advisor in Southborough, MA to leverage pharmacy acumen and payer knowledge for PA reviews, policy development, and analytics within Pharmacy Operations. The role involves collaborating with pharmacists and technicians to support PA processes and quality programs.

The ideal candidate has PharmD, PBM experience, and strong analytical and communication skills, with a focus on regulatory compliance and patient outcomes.