Clinical Pharmacist Operations Manager

TruDataRx•Brentwood, TN

12d

About The Position

The Clinical Pharmacist Operations Manager is responsible for leading the day-to-day clinical operations of the Utilization Management (UM) Pharmacist organization. This role ensures exceptional clinical adjudication accuracy, regulatory compliance, operational efficiency, and strict adherence to turn-around-time (TAT) service level agreements (SLAs) across all prior authorization and appeals workflows. In addition to serving as the operational leader for the UM Pharmacist team, this role acts as the primary business owner for our Utilization Management platform, holding end-to-end responsibility for system maintenance, clinical workflow design, and the technical configuration of clinical decision trees. This position directly manages the Clinical Pharmacist Supervisors and the Clinical Pharmacist QA & Training Specialist, fostering a culture of clinical excellence, data-driven decision-making, and continuous professional development.

Requirements

Ability to work well with others in a collaborative environment
Ability to get things done with resources you don’t control
Willingness to admit you don’t know and ask for help
Exhibit constant curiosity and a drive to problem solve
Exhibit desire to learn and grow on a continuous basis

Nice To Haves

Direct experience with custom low-code/no-code rules engine builders, Salesforce Health Cloud, or specialized PBM claim processing architectures.
Experience leading remote or hybrid clinical operations teams.
Familiarity with comparative effectiveness research, specialty drug pipelines, and advanced medical benefit drug management.

Responsibilities

Lead the daily operations of the UM Clinical Pharmacist team, ensuring compliant, timely, and evidence-based adjudication of prior authorizations, complex coverage determinations, and appeals.
Oversee clinical workload distribution, shift coverage, and capacity planning to consistently meet or exceed regulatory and client-specific SLA turn-around times.
Partner closely with the PSS Operations Manager to ensure seamless end-to-end coordination between front-line intake/coordination teams and clinical review queues.
Serve as the final internal clinical escalation point for complex coverage decisions, high-impact appeal determinations, and peer-to-peer consult strategies.
Act as the primary operational and clinical business owner for the Utilization Management software engine.
Oversee the build and directly execute the testing, maintenance, and technical configuration of clinical decision trees and decision-support logic within the UM platform.
Translate complex health plan criteria, medical policies, and evidence-based clinical guidelines into clear, automated digital workflows that reduce friction and improve pharmacist review efficiency.
Partner with both internal and external teams to prioritize platform enhancements, troubleshoot system bugs, and oversee user acceptance testing (UAT) for clinical system releases.
Manage, mentor, and evaluate Clinical Pharmacist Supervisors and the Clinical Pharmacist QA & Training Specialist, building strong leadership capabilities across the department.
Establish clear operational and clinical benchmarks; conduct regular performance reviews, track productivity metrics, and implement targeted coaching plans when variations occur.
Foster a collaborative, growth-oriented environment focused on clinical rigor, quality patient care, and continuous learning.
Oversee recruitment, interviewing, and selection of incoming clinical leadership and staff pharmacists.
Direct the Clinical QA & Training Specialist in establishing audit standards, calibration sessions, and quality scorecards across the pharmacist team.
Ensure all clinical adjudication processes comply strictly with state/federal regulations and align with best practices across the industry.
Analyze operational metrics (case accuracy, overturn rates, average review times, decision tree pass-through rates) to generate actionable reporting for senior leadership.
Diagnose underlying drivers of workflow bottlenecks or clinical quality drops and implement sustainable, systemic solutions.