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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.
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.
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
Minimum Qualifications
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
Additional Qualifications
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
Preferred Qualifications
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
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 (
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.
