Remote Utilization Review Jobs in Albuquerque, NM

At Prime Therapeutics (Prime), we are a different kind of PBM, with a purpose beyond profits and a unique ability to connect care for those we serve. Looking for a purpose-driven career? Come build the future of pharmacy with us.
Job Posting Title
Sr. Dir. Clinical Acct Services - RemoteJob Description
Manages the overall clinical services delivered to customers and various pharmacy benefit programs, including all activities associated with clinical account management in support of innovative Medicaid pharmacy benefit management. This includes clinical and utilization management, mac operations, analysis, financial management, quality assurance, and regulatory compliance, ensuring customers reduce expenses and improve care.
Responsibilities

• Supervises staff including Clinical Services Managers, Clinical Pharmacists, pharmacy technicians, and the MAC operations manager.
• Directs, coordinates and supervises all clinical pharmacy client activities including pharmacy benefit management solutions and services.
• Oversees, mentors and guides achievement of monthly, quarterly, and annual projections based on financial and management objectives.
• Serves as SME for Clinical Services for all new business RFPs, enlisting help from other SMEs as needed.
• Oversees, mentors and supports leadership of pharmacy program implementation including new clients, product extensions, and other important clinical initiatives.
• Designs, implements, monitors and provides appropriate feedback on metrics based performance measurement tools.
• Drives marketing opportunities through market research, upsell across product lines and mentoring of all levels of customer clinical services.
• Maintains currency with clinical skills and knowledge of pharmacotherapy by reviewing the literature and attending in- services, seminars, and conferences.

Minimum Qualifications

• Bachelors - Pharmacy

• 10+ years Pharmacy
• 2+ years Medicare Part D (MedD)
• 5+ years Marketing
• RPH - Registered Pharmacist - Pharmacy

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

• Possess a strong knowledge base in Medicaid PBM.
• Possess the necessary customer service and supervisory/management skills and/or experience to supervise the clinical pharmacy services aspects for customers.

Preferred Qualifications

• PharmD - Doctor Of Pharmacy, State Licensure - Pharmacy

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
Every employee must be able to perform the essential functions of the job and, if requested, reasonable accommodations will be made to enable employees with disabilities to perform the essential functions, absent undue hardship. In addition, Prime retains the right to change or assign other duties to this job.
Potential pay for this position ranges from $143,000.00 - $243,000.00 based on experience and skills.
To review our Benefits, Incentives and Additional Compensation, visit our Benefits Page and click on the "Benefits at a glance" button for more detail (https://www.primetherapeutics.com/benefits).
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, color, religion, gender, sex (including pregnancy), national origin, disability, age, veteran status, or any other legally protected class under federal, state, or local 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.