Our work matters. We help people get the medicine they need to feel better and live well.  We do not lose sight of that. It fuels our passion and drives every decision we make.

Job Posting Title

Clinical Pharmacist Reviewer - LouisianaJob Description

The Clinical Pharmacist is responsible for the clinical and regulatory analysis activities required for the implementation of clinical and regulated programs, including coverage lists in support of client benefits. This position is responsible for participating in internal, client-initiated and regulatory projects. This position is also responsible for supporting quality assurance needs and analytical activities related to benefit plans.

Candidate must reside in the state of Louisiana.

Responsibilities

Partner with Quality Audit team and/or other roles to develop and maintain project and benefit plan testing scenarios including utilization management, specialty and new client offeringsInterpret project requests to determine feasibility, develop business requirements and assist with developing technical solutionsDocument process for execution and conduct User Acceptance Testing (UAT) for quality assuranceIdentify system problems, resolve set-up issues and/or escalate system defects with a sense of urgency to avoid member disruptionEnsure benefit plans are in compliance with all regulations including federal, CMS, state, local and pharmacyDevelop, maintain and verify drug lists with claims adjudication systems to support benefit coverage decisions and contingent therapy, quantity limits, and prior authorization programsDevelop and maintain point of service messages and concurrent Drug Utilization Review table settings, and ensure accuracy of claims adjudication through weekly MediSpan product file maintenance and quarterly P&T implementation decisionsOther duties as assigned

Education & Experience

Doctor of Pharmacy (PharmD) or Bachelor of Science Pharmacy DegreeCurrent pharmacist license in good standing with the State Board of Pharmacy in the State where the position is located1 year of work experience in clinical, retail, hospital, or managed careMust be eligible to work in the United States without need for work visa or residency sponsorship

Must be eligible to work in the United States without the need for work visa or residency sponsorship.

Additional Qualifications

Strong analytical and problem-solving skills with attention to detail and qualityAbility to work on multiple projects simultaneously under pressure with strict timelinesAbility to develop process efficienciesAbility to work well in team environmentMicrosoft Excel and Word proficiency

Preferred Qualifications

MediSpan or First Databank experienceFormulary Database management experienceKnowledge of AS400, queries, and Lotus NotesRxClaim experience

Physical Demands

Ability to work a flexible schedule including weekends, holidays, additional hours during peak season, on-call, and shifts outside of Prime's core business hours of 9:00 a.m. to 3:00 p.m.Constantly required to sit, use hands to handle or feel, talk and hearFrequently required to reach with hands and armsOccasionally required to stand, walk and stoop, kneel, and crouchOccasionally required to lift and/or move up to 10 pounds and occasionally lift and/or move up to 25 poundsSpecific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus

Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their job, and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures.

 

Potential pay for this position ranges from $108,000.00 - $184,000.00 based on experience and skills.

Prime Therapeutics LLC is proud to be an equal opportunity and affirmative action employer. We encourage diverse candidates to apply, and all qualified applicants will receive consideration for employment without regard to race, creed, color, religion, gender, sexual orientation, gender identity/expression, national origin, disability, age, genetic information, veteran status, marital status, pregnancy or related condition (including breastfeeding), expecting or parents-to-be, or any other basis protected by law. 

We welcome people of different backgrounds, experiences, abilities, and perspectives including qualified applicants with arrest and conviction records and any qualified applicants requiring reasonable accommodations in accordance with the law.

Prime Therapeutics LLC is a Tobacco-Free Workplace employer.

Positions will be posted for a minimum of five consecutive workdays.