Clinical Pharmacist – Operations Manager

This is a fully remote position, open to applicants in Tennessee.

📋 Description

• Oversee the daily functions of the Utilization Management Clinical Pharmacist team.

• Ensure that prior authorizations, complex coverage determinations, and appeals are adjudicated in a compliant, timely, and evidence-based manner.

• Manage workload distribution, shift coverage, and capacity planning to adhere to regulatory and client-specific SLA turn-around times.

• Coordinate front-line intake and clinical review teams with the review queues.

• Act as the final internal escalation point for complex coverage decisions and significant appeal determinations.

• Take ownership of the Utilization Management software system and supervise its maintenance.

• Develop, test, maintain, and technically configure clinical decision trees and decision-support logic.

• Convert health plan criteria, medical policies, and clinical guidelines into automated digital workflows.

• Collaborate with internal and external teams on platform improvements, bug fixes, and user acceptance testing.

• Manage, mentor, and assess the performance of Clinical Pharmacist Supervisors and the Clinical Pharmacist QA & Training Specialist.

• Set benchmarks, conduct performance evaluations, track productivity metrics, and implement coaching strategies.

• Cultivate a collaborative, growth-focused environment emphasizing clinical rigor and ongoing learning.

• Oversee the recruitment, interviewing, and selection processes for clinical leadership and staff pharmacists.

• Direct clinical audit standards, calibration sessions, and quality scorecards.

• Ensure adherence to state and federal regulations.

• Analyze operational metrics and prepare reports for senior leadership.

• Identify workflow bottlenecks or clinical quality issues and implement systemic solutions.

• Perform additional duties as needed.

⛳️ Requirements

• Direct experience with custom low-code/no-code rules engine builders, Salesforce Health Cloud, or specialized PBM claim processing architectures.

• Experience in leading remote or hybrid clinical operations teams.

• Familiarity with comparative effectiveness research, specialty drug pipelines, and advanced medical benefit drug management.

• Ability to collaborate effectively in a team-oriented environment.

• Capacity to achieve results with limited resources under your control.

• Openness to acknowledging gaps in knowledge and seeking assistance.

• Demonstration of continuous curiosity and a proactive problem-solving approach.

• Commitment to ongoing learning and personal growth.

🏝️ Benefits

• Fully remote work arrangement.

• Remote work option available for candidates in Nashville, TN is preferred.