Clinical Pharmacist – Pulse PBM

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

📋 Description

• Act as the clinical leader for new client implementations, guiding plan sponsors and brokers through the process of benefit design decisions.

• Convert client benefit design choices into clinical edits, prior authorization standards, step therapy protocols, and quantity limitations.

• Evaluate prior PBM claims and formulary data to suggest transition-of-care strategies.

• Oversee pharmacy claims in real-time for high-cost claims, inappropriate utilization, safety issues, and potential savings.

• Propose therapeutic interchanges, generic and biosimilar alternatives, along with cost-effective options.

• Collaborate with prescribers and members to facilitate therapy modifications.

• Review clinical analyses for prior authorizations, formulary exceptions, and coverage decisions.

• Conduct drug utilization reviews that are prospective, concurrent, and retrospective.

• Manage and implement cost-containment initiatives, including international pharmacy, 340B, and manufacturer patient assistance programs.

• Create clinical and financial reports that detail utilization trends, cost drivers, specialty expenditures, program savings, and clinical outcomes.

• Develop clinical content for and engage in quarterly business reviews.

• Act as a clinical point of contact for plan sponsors, brokers, TPAs, and members.

• Interact with members and prescribers regarding therapy modifications, program enrollment, and coverage decisions.

• Compose communications for members and clients.

• Partner with pharmacy executives, account management, operations, and claims processing teams.

• Provide guidance on new drug approvals, pipeline developments, guideline updates, biosimilar releases, and patent expirations.

• Maintain documentation while ensuring compliance with HIPAA, ERISA, ACA, state pharmacy regulations, and internal policies.

⛳️ Requirements

• Doctor of Pharmacy (PharmD) degree from an ACPE-accredited college of pharmacy.

• Active, unrestricted pharmacist license in good standing, with the capability to obtain additional state licenses as necessary.

• At least 1 year of pharmacist experience in a PBM, managed care, health plan, or clinical pharmacy environment.

• Proficient understanding of formulary management, utilization management, prior authorization criteria, and specialty pharmacy.

• Familiarity with PBM economics, including net costs, rebates, pricing, and pass-through models.

• Knowledge of cost containment programs such as copay maximizer, 340B, and patient assistance initiatives.

• Strong analytical capabilities, especially in working with claims data and advanced Excel.

• Exceptional written and verbal communication skills, with the ability to present information effectively to clients, brokers, and executives.

• Detail-oriented with the ability to manage multiple clients, deadlines, and priorities in a dynamic environment.

🏝️ Benefits

• Competitive salary and performance-based incentives.

• Comprehensive health benefits, including medical, dental, and vision coverage.

• Opportunities for professional development and continuing education.

• Collaborative work environment with a focus on innovation and improvement.

• Flexible work arrangements to promote work-life balance.