Provider Liasion Pharmacists - Middle TN
About The Position
The Clinical Pharmacist delivers clinical and regulatory analysis supporting operations and implementation of clinical and regulated programs, including benefit-plan coverage lists, formulary management, and publications. The role participates in internal and client-initiated projects, conducts analysis, and ensures compliance with quality assurance standards. It provides direct support for benefit-plan functions and contributes to regulatory requirements and pharmacy-related initiatives. The position partners with internal stakeholders and clients on project and benefit-plan testing, interprets requests and documents requirements, performs quality-assurance testing, resolves system issues, and supports regulatory compliance. It also maintains and verifies drug-utilization and claims-adjudication data, supports Drug Utilization Review workflows, and helps implement client-requested formulary changes.
Requirements
- Doctor of Pharmacy (PharmD) or Bachelor of Science Pharmacy degree.
- At least 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 and strict timelines.
- Skill in developing and improving process efficiencies.
- Strong collaboration skills and ability to work in a team-oriented environment.
- Proficiency with Microsoft Excel and Word.
- Must understand, comply with, and attest to job-specific security responsibilities and controls, and comply with applicable legal, regulatory, contractual, and internal requirements.
- Must be able to perform the essential functions of the job; reasonable accommodations will be made upon request absent undue hardship.
Nice To Haves
- MediSpan or First Databank experience.
- Formulary database or workplace management tool experience.
- Claims-adjudication system experience.
- Board of Pharmacy Specialties (BPS) certification, pharmacy residency, or fellowship.
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 comply with federal, CMS, state, local, and pharmacy regulatory requirements.
- 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.
- Perform other duties as assigned.
Benefits
- Benefits, incentives, and additional compensation are referenced on the company's Benefits Page; specific benefits are not listed in the posting.
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What This Job Offers
Job Type
Full-time
