Clinical Pharmacist – Cost Containment
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Job Description
Clinical Pharmacist optimizing medication utilization and cost-containment programs for TrueScripts, a transparent prescription benefit manager. Analyzing clinical and financial outcomes while supporting PBM operations.
Responsibilities:
- Provide clinical pharmacy expertise to support development, implementation, and ongoing management of cost containment programs
- Evaluate prescription drug utilization, prescribing patterns, formulary opportunities, and emerging therapies to identify cost savings
- Design and refine programs promoting clinically appropriate, cost-effective medication utilization
- Evaluate new program opportunities for clinical appropriateness, operational feasibility, financial impact, and member implications
- Evaluate medication disruption and transition opportunities for new business members
- Review physician and member inquiries and appeals related to clinical appropriateness of drug or pharmacy alternatives
- Provide ongoing clinical support for assigned programs, including setup, implementation, maintenance, and continuous improvement
- Develop and maintain clinical criteria, workflows, documentation, and operational guidance
- Resolve complex clinical questions, exceptions, and escalations
- Identify workflow gaps, reduce manual processes, and improve program efficiency
- Monitor program performance and identify opportunities to improve effectiveness, consistency, and scalability
- Analyze drug utilization, claims trends, prescribing patterns, and related data
- Evaluate program performance and validate savings opportunities with Analytics, Finance, and stakeholders
- Develop program metrics, reporting, and performance dashboards
- Review results, identify trends and unexpected outcomes, and recommend adjustments
- Document program value and communicate clinical and financial results to stakeholders and clients
- Partner cross-functionally with Pharmacy Networks, Client Services, Implementation, Compliance, and other departments
- Provide clinical education and guidance to internal team members
- Participate in client discussions, program reviews, and internal strategy sessions
- Support standardized processes, resources, and training materials
- Support compliance with federal and state requirements, contractual obligations, clinical standards, and internal policies
- Maintain documentation of clinical decisions, program criteria, and changes
- Identify risks, quality concerns, and process gaps and escalate them
- Stay current on pharmaceutical trends, emerging therapies, drug pricing, and industry practices
- Recommend process improvements supporting program quality and scalable growth
Requirements:
- Doctor of Pharmacy (Pharm.D.) degree from an accredited college of pharmacy
- Active pharmacist license in good standing in the state of residence, with the ability to obtain additional licensure as required by the position
- Strong clinical knowledge of pharmacotherapy, medication utilization, formulary management, and evidence-based prescribing
- Demonstrated analytical, problem-solving, and critical-thinking skills
- Ability to interpret clinical information and translate findings into practical recommendations
- Strong written and verbal communication skills
- Ability to collaborate effectively across departments and with stakeholders at varying levels of the organization
- Strong organizational skills and ability to manage multiple priorities in a growing, fast-paced environment
- Experience working in a pharmacy, PBM, healthcare, or clinical environment preferred
- Familiarity with formulary management or pharmacy benefit operations preferred
- Experience supporting clinical programs or healthcare initiatives preferred
- Experience with spreadsheets, reporting tools, workflow systems, or project-management tools preferred
- Familiarity with pharmacy terminology and clinical program concepts preferred
- Experience documenting processes and developing standard operating procedures preferred
- SQL experience is a plus
Benefits:
- A wide range of health insurance options including medical, dental and vision
- A strong salary and bonus program
- A robust 401k and company match
- ESOP shares allocated each year through a qualified retirement plan
- Employee Assistance Program
- Wellness program including financial incentives, chiropractic and massage services, and fitness stipends
- Dream Manager Program
- Cohesive, family-based culture
- Charitable contributions and volunteer time
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