Clinical Programs Pharmacist at Veracity Benefits

Kennesaw, Georgia, United States -

Full Time

Start Date

Immediate

Expiry Date

22 May, 26

Salary

130000.0

Posted On

21 Feb, 26

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Prior Authorization, Utilization Management, Clinical Criteria Development, Formulary Strategy, Clinical Resource, PBM Collaboration, Clinical Judgment, Analytical Skills, Documentation, Time Management, Collaboration, Strategic Thinking

Industry

Insurance

Description

Description The Clinical Pharmacist will receive direction from the Sr. Director of Pharmacy Solutions to support the development, implementation, and oversight of clinical programs. This position is responsible for reviewing and adjudicating prior authorization requests, developing and maintaining evidence-based clinical criteria, and serving as a clinical resource for pharmacy technicians and cross-functional teams. The role ensures safe, appropriate, and cost-effective medication use while aligning with client benefit design and regulatory requirements. They will assist in the communication between members, brokers, HR, and their direct report needed to ensure retention and operational excellence. Requirements Key Responsibilities Prior Authorization & Utilization Management Review and provide oversight of complex or escalated prior authorization requests Document clinical determinations clearly and accurately Participate in peer-to-peer discussions when necessary Develop and maintain evidence-based prior authorization criteria, step therapy protocols, and quantity limits Ensure alignment between clinical guidelines, plan documents, and operational execution Identify opportunities to enhance clinical rigor while maintaining operational efficiency Formulary & Benefit Strategy Support Assist in formulary evaluation and design recommendations Evaluate clinical and financial impact of new brand and generic launches Monitor therapeutic class changes, pipeline drugs, and specialty trend drivers Support clinical discussions and clinical program recommendations Clinical Resource & Operational Support Serve as a clinical subject matter expert for pharmacy technicians and operations teams Provide guidance on complex medication cases and high-cost therapies Assist with training on criteria updates and program enhancements Performs other duties as assigned Vendor & PBM Collaboration Partner with PBM clinical teams to ensure accurate execution of criteria Review PBM performance metrics related to prior authorization and utilization management Assist in identifying gaps or inconsistencies in PBM clinical application Qualifications Required Doctor of Pharmacy (PharmD) Active, unrestricted pharmacist license in good standing 2+ years of clinical pharmacy experience (managed care, PBM, specialty, or retail) Strong knowledge of utilization management tools (PA, step therapy, quantity limits) Preferred Experience reviewing prior authorizations Experience developing clinical criteria Key Competencies Strong clinical judgment and analytical skills Ability to balance clinical appropriateness with financial stewardship Excellent written documentation skills Detail-oriented with strong time management abilities Ability to work collaboratively across clinical and operational teams Ability to balance clinical appropriateness with financial stewardship Strategic thinker who can move between individual case review and population-level impact Physical Requirements (Essential Functions) · Ability to remain in a stationary position (sitting or standing) for prolonged periods while reviewing clinical documentation and adjudicating cases. · Ability to operate standard office and computer equipment, including keyboard, mouse, telephone, and workstation tools. · Ability to communicate effectively in both verbal and written formats. · Sufficient visual acuity to review electronic medication records, clinical documentation, and system tools. · Occasional movement throughout the office to attend meetings or collaborate with colleagues. · Occasional lifting or movement of office items or materials up to 20–25 pounds. Work Environment · Primarily a professional office environment located at 1701 Barrett Lakes Blvd, Suite 150, Kennesaw, GA. · Hybrid or remote flexibility may be available based on departmental needs. · Work involves extensive computer and telephone use. · Noise level is generally low to moderate. Schedule & Other Requirements · May occasionally be required to work beyond standard business hours. · Occasional travel may be required for vendor meetings, conferences, or operational oversight. · Must be able to perform essential job functions with or without reasonable accommodations.

Responsibilities

The Clinical Pharmacist supports the development, implementation, and oversight of clinical programs, focusing on reviewing and adjudicating prior authorization requests and developing evidence-based clinical criteria. This role also serves as a clinical resource, ensuring safe, appropriate, and cost-effective medication use aligned with client benefits and regulations.