Principal Clinical Pharmacist

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

📋 Description

• Assist in the development of prior authorization programs by converting approved clinical criteria, coverage requirements, client guidelines, and workflow necessities into build specifications.

• Collaborate with cross-functional teams to set up PA workflows, clinical logic, renewals, letters, routing, reporting, and operational procedures.

• Develop and maintain test scenarios, test cases, validation documentation, and requirements traceability.

• Engage in QA, unit, integration, UAT, regression, and production testing for PA builds and updates.

• Verify PA workflows and clinical logic align with approved policies, client specifications, regulations, and operational expectations.

• Identify and document configuration problems, workflow deficiencies, risks, and clinical inconsistencies; assist in resolution efforts.

• Ensure production readiness by confirming that requirements, testing, documentation, reporting, procedures, and approvals are finalized.

• Manage PA criteria, drug class reviews, clinical policies, and evidence-based materials.

• Utilize claims, PA, utilization, quality, and trend data to aid in analysis, investigations, and program enhancements.

• Support clinical program operations, including PDL, provider engagement, adherence, safety, specialty pharmacy, quality, and population health initiatives.

• Deliver senior-level clinical and operational guidance to enhance quality, compliance, workflows, and program performance.

• Mentor team members on PA workflows, configuration, testing, clinical rationale, and best practices.

⛳️ Requirements

• An active pharmacist license in good standing is required.

• PharmD is preferred; a Bachelor of Pharmacy degree is acceptable.

• Preferred: At least 7 years of progressive experience in clinical pharmacy, managed care, PBM, Medicaid pharmacy, prior authorization, pharmacy operations, or similar clinical program operations.

• Strongly preferred: Hands-on experience in supporting prior authorization builds, clinical criteria implementation, pharmacy benefit or PA configuration, workflow setup, operational requirements, or system-enabled clinical programs.

• Strongly preferred: Experience in participating directly in QA, unit testing, system integration testing, user acceptance testing, regression testing, defect review, production validation, or implementation readiness activities.

• Preferred: Experience in translating clinical policy, coverage criteria, client requirements, regulatory expectations, and operational workflows into build specifications, configuration inputs, test cases, and validation documentation.

• Preferred: Strong knowledge of Medicaid pharmacy programs, managed care pharmacy, PBM operations, state and federal requirements, regulatory expectations, and pharmacy-related Medicaid requirements.

• Preferred: Experience supporting P&T Committee activities, DUR Board activities, PDL management, DUR initiatives, academic detailing, population health, clinical quality, provider outreach, or clinical program improvement.

• Experience in working collaboratively with clinical, operations, configuration, technology, reporting, product, account management, client-facing teams, and leadership stakeholders.

• Proficient in Microsoft Office products and able to quickly adapt to proprietary systems, workflow tools, reporting platforms, and configuration or testing tools.

🏝️ Benefits

• Benefits commence on Day One.

• Flexible working hours.

• Commitment to work-life balance.

• Opportunities for continuous learning and career advancement.

• Remote work options available across the United States.

• Generous and flexible vacation policy.

• 401(k) employer matching.

• Comprehensive health benefits package.

• Educational assistance provided.

• Leadership and technical development academies available.