Position Overview
CerpassRx is seeking an experienced and knowledgeable Clinical Pharmacist to support the development and delivery of clinical pharmacy programs and services. In this role, you will be responsible for evaluating pharmacy data, developing evidence-based prior authorization criteria, reviewing coverage determinations, and providing clinical insights to clients. The ideal candidate will bring a strong background in pharmacy benefit management (PBM), a commitment to data-driven decision-making, and excellent communication skills to engage clients, internal teams, and stakeholders.
Key Responsibilities
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Clinical Review & Determinations:
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Develop, update, and maintain clinical criteria for prior authorization and coverage determinations.
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Review and adjudicate coverage requests and member appeals in alignment with evidence-based standards.
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Product & Program Support:
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Assist with the daily operations and strategic development of clinical programs and products.
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Monitor pharmacy claims and operational processes to ensure accurate and compliant service delivery.
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Client Consultation:
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Analyze pharmacy data to identify trends, opportunities, and cost-saving recommendations for clients.
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Deliver clear, insightful clinical presentations and performance reports to clients, brokers, and consultants.
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Serve as a clinical liaison between external partners and internal departments to ensure alignment and excellence in service delivery.
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Collaboration & Training:
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Train and mentor new and existing staff on clinical guidelines, operational procedures, and best practices.
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Promote a collaborative, team-oriented culture and support the professional development of colleagues.
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Compliance & Confidentiality:
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Maintain strict adherence to HIPAA and all applicable regulatory standards in handling sensitive health information.
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Participate in special projects and fulfill additional responsibilities as assigned.
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Qualifications
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Education & Licensure:
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Doctor of Pharmacy (Pharm.D.) degree from an accredited institution.
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Active, unrestricted pharmacist license in good standing.
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Experience & Skills:
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Minimum of 2 years of experience within the pharmacy benefit management (PBM) industry preferred.
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Familiarity with clinical resources and healthcare regulatory websites.
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Proficient in MS Office applications, including Word, Excel, PowerPoint, and Outlook.
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Strong analytical, critical thinking, and organizational skills.
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Excellent verbal and written communication abilities, with the capacity to tailor content to varied audiences.
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Self-starter who thrives in both independent and team environments.
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Committed to accuracy, confidentiality, and professional accountability.
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Physical Requirements
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Regularly required to talk, hear, and use hands for typing and handling materials.
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Frequently required to sit for extended periods; occasionally required to stand or walk.
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Must be able to lift or move up to 10 pounds occasionally.
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Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions.
Work Environment
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This role is performed in a standard office environment, with accommodations available as needed for individuals with disabilities.