[Remote] Clinical Administrative Pharmacist - Remote TN

Note: The job is a remote job and is open to candidates in USA. Prime Therapeutics is hiring a Clinical Administrative Pharmacist to support clinical and regulatory analysis, benefit plan operations, and implementation of clinical and regulated programs. The role conducts project and quality assurance testing, supports formulary management and claims adjudication, and helps ensure regulatory compliance.

Responsibilities

• Partner with internal stakeholders and clients to develop and maintain project and benefit plan testing scenarios, including utilization management and specialty offerings
• Interpret project requests to determine feasibility, document requirements, and provide technical solutions
• Conduct testing, including test plan creation, test execution, and User Acceptance Testing for quality assurance
• Identify and resolve system issues, perform root-cause analysis, and escalate problems to avoid service disruption
• Ensure benefit plans remain in compliance with all regulatory requirements (federal, CMS, state, local, and pharmacy)
• Develop, maintain, and verify data for drug utilization and claims adjudication systems to support evidence-based benefit coverage decisions
• Support concurrent Drug Utilization Review service messages, table settings, testing and adjudication workflows to ensure accuracy and compliance with established protocols and implementation decisions
• Collaborate with leaders to implement client-requested formulary changes and provide subject-matter expertise to internal and external committees
• Other duties as assigned

Skills

• Doctor of Pharmacy (PharmD) or Bachelor of Science Pharmacy Degree
• 1 year of work experience in clinical, retail, hospital, or managed care
• Current Pharmacist license to practice in the applicable state(s)
• Must be eligible to work in the United States without the need for work visa or residency sponsorship
• Knowledge of AS400, queries, and Lotus Notes
• Strong analytical and problem-solving skills with attention to detail and quality
• Ability to manage multiple projects simultaneously under pressure with strict timelines
• Skilled in developing and improving process efficiencies
• Strong collaboration skills and ability to work in a team-oriented environment
• Proficiency with Microsoft Excel and Word
• MediSpan or First Databank experience
• Formulary Database/Workplace management tool experience
• Claim adjudication system experience
• Board of Pharmacy Specialties (BPS) certification, pharmacy residency, or fellowship

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