Senior Clinical Operations Specialist

RXinsider LTD.; West Des Moines, Northern (IA, KY); Hybrid; USD 110,000 - 165,000; Full time

Benefits offered by this job

Medical benefits

Dental & Vision plans

HSA & FSA

Job summary

RXinsider LTD. seeks a Pharmacist to lead clinical service design and oversee clinical configurations for the Insight engine, acting as a senior clinical operations specialist for internal and external stakeholders.

You will develop MTM-based programs, collaborate with product teams, and ensure CMS-aligned guidelines while driving opportunities across networks and improving service offerings.

Qualifications

• Minimum 5 years of work experience in pharmacy or clinical operations.
• Experience with MTM is preferred.
• Strong proficiency with Microsoft Office products.

Responsibilities

• Develop and maintain clinical rules for the Insight Clinical Engine.
• Design and implement new clinical programs aligned with client needs and company priorities.
• Implement and maintain clinical programs per CMS guidelines and quality measures.
• Develop service attributes and coordinate with product, clinical program management, quality, and technology teams to define requirements.
• Evaluate clinical reporting and define enhancement requirements.
• Participate in national meetings, trade shows, and client visits as needed.
• Answer clinical questions from the Network.
• Serve as process owner for at least one operational task/project.
• Serve as product SME for at least one Outcomes product offering with Product Managers.

Skills

MTM experience

Microsoft Office

Organizational skills

Time management

Communication skills

Interpersonal skills

Detail-oriented

Solution oriented

Prioritization

Adaptability

Cross-functional communication

Travel willingness

Education

Pharmacy Degree (BS or PharmD)

Active pharmacist license

Job description

Job Summary

Pharmacist who manages clinical service design and associated clinical configurations, serves as senior clinical operations specialist for both internal and external stakeholders, provides ongoing support and management of the Insight clinical engine, oversees and manages clinical opportunity generation processes. This role is also responsible for serving as a Clinical liaison with product teams..

• Develop and maintain clinical rules for the Insight Clinical Engine
• Design and implement new clinical programs that align with client requests, network pharmacist capabilities and company priorities
• Implement and maintain clinical programs in accordance with CMS guidelines and regulations, quality measures, and clinical guidelines
• Develop and maintain service attributes
• Develop concepts for new covered services and coordinate with Product, Clinical Program Management, Quality Management, and technology teams to define requirements
• Continually evaluate clinical reporting and define requirements for enhancements, as needed
• Participate in national industry meetings, trade shows, and client visits, as needed
• Answer clinical questions from the Network
• Serve as a process owner for at least one operational task/project
• Serve as a product SME for at least one Outcomes product offering by collaborating with Product Managers to develop and/or improve product offerings

KNOWLEDGE & REQUIREMENTS

• Experience with MTM, preferred
• Proficient in Microsoft Office products
• Strong organizational and time management skills
• Ability to work collaboratively and independently while managing multiple projects, assignments, and responsibilities
• Excellent communication and interpersonal skills
• Highly organized
• Must be able to manage competing demands and multiple priorities, while maintaining a strong attention to detail
• Solution oriented
• Excellent time management skills
• Prioritization skills and goal setting
• Adaptable to learn new processes, concepts, and skills
• Ability to communicate across all levels of an organization, demonstrating professionalism and good judgment at all times
• Travel Requirements Domestic and or International, up to 10%

Education & Experience Requirements

• Minimum years of work experience: 5 year
• Minimum level of education or education/experience:
  • Pharmacy Degree (BS or PharmD)
  • Active pharmacist license in good standing with a state board of pharmacy

Physical Requirements

• Frequent sitting in stationary position at a desk
• Occasional standing, walking, stooping, kneeling, squatting, and climbing stairs
• Occasional twisting of body
• Occasional reaching by extending hands and arms in any direction
• Occasional lifting, pulling, or pushing

What’s In It For You?

• Medical, Dental and Vision Plans
• Voluntary Benefits
• HSA & FSA
• Fertility & Family Planning Benefits
• Paid Parental Leave
• Adoption Assistance Program
• Employee Resource Groups
• Flex PTO for Exempt Associates & up to 15 PTO days in first year of employment for non-exempt associates
• 11 Paid Holidays
• Corporate Wellness Program
• 401k Employer Match & Roth Option Available – immediate eligibility