Director, Specialty Clinical Solutions- REMOTE
Prime Therapeutics•Home, WV
•$143,000 - $243,000•Remote
About The Position
The Specialty Clinical Solutions Director Senior is responsible for overseeing the clinical services and strategies within the Medical Pharmacy & Specialty programs delivered to customers including clinical and utilization management, analysis, innovation, financial management, regulatory & quality compliance, and contractual obligations.
Requirements
- Doctor of Pharmacy (PharmD) or Bachelor of Science Pharmacy degree
- 7 years of work experience in medical pharmacy or at Health Plan with multiple lines of business
- 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
Nice To Haves
- Strong interpersonal & communication, consultation, organizational, tracking and follow-up skills
- Ability to research, obtain, coordinate, and integrate feedback from diverse operational groups
- Excellent verbal and written communication skills
- Strong presentation skills who exude high confidence in project output and production
- Medical Pharmacy management, strategy & data interpretation experience at a health plan
- Health plan experience managing drugs on both the Pharmacy and Medical benefit across all lines of business
Responsibilities
- Serve as the lead clinical consultant and subject matter expert for assigned clients, providing strategic guidance on medical pharmacy and specialty programs
- Partner with account management and business development teams to support client retention, growth opportunities, financial analyses, and new business initiatives
- Develop and advance innovative medical pharmacy strategies through data-driven insights, clinical solution design, and program enhancements
- Evaluate emerging therapies, market trends, and medical benefit drug management opportunities to improve clinical outcomes, affordability, and client value
- Oversee client-facing medical pharmacy programs and utilization management solutions, including fee schedule management, prior authorization, post-service claim edits, and related programs
- Identify opportunities to expand existing programs and recommend new solutions that address evolving client and market needs
- Colloborate with cross-functional teams to evaluate program performance, develop business rules, deliver actionable insights, and drive continuous improvement through enhanced reporting and operational efficiencies
- Lead the development of client-facing clinical materials, strategic presentations, thought leadership content, and industry-facing publications
- Represent the organization as a clinical expert and mentor through industry engagement, enterprise initiatives, conference presentations, and guidance to peers and cross-functional partners
- Other duties as assigned
Benefits
- Benefits, Incentives and Additional Compensation
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What This Job Offers
Job Type
Full-time
Career Level
Director
