Clinical Pharmacist

About Imagine360

Imagine360 is a health plan solutions company with over 50 years of combined expertise in self-funded healthcare. The company has helped numerous employers substantially reduce healthcare costs by offering tailored, member-focused plans that address the deficiencies of generic PPO insurance options.

Role Overview

The Clinical Pharmacist focusing on clinical and prior authorization reviews will be tasked with assessing medication prior authorization requests to ensure the safe, effective, and economical use of pharmaceutical therapies. This position collaborates closely with healthcare practitioners, care management teams, pharmacy operations, and health plan stakeholders to facilitate evidence-based clinical decisions while remaining compliant with regulatory and company policies. The role is performed fully remotely within the United States.

Key Responsibilities

• Review pharmacy and medical prior authorization requests for safety, effectiveness, guideline adherence, and appropriate use.
• Apply formulary standards, utilization management strategies, and evidence-based treatments when determining medication coverage.
• Assess specialty drug requests, step therapy exceptions, quantity limits, and formulary exceptions.
• Make authorization decisions promptly in compliance with regulatory timelines and organizational policies.
• Accurately document clinical justifications and authorization outcomes in utilization management systems.
• Analyze individual patient clinical data, including diagnoses, lab results, drug histories, and provider notes to ensure medication appropriateness.
• Ensure therapeutic regimens comply with current clinical guidelines, approved FDA indications, and best clinical practice.
• Identify opportunities to optimize pharmacotherapy, improve patient outcomes, and reduce costs for clients and patients.
• Support activities related to formulary management, medication utilization reviews, and quality improvement initiatives.
• Engage collaboratively with prescribers and clinical staff to obtain necessary clinical information and provide educational support on formulary choices and treatments.
• Respond to inquiries from providers concerning authorization requirements and coverage policies.
• Manage pharmacy-related appeals, exceptions, and reconsiderations by preparing clinical reviews and recommendations.
• Ensure adherence to regulatory requirements, accreditation standards, and organizational protocols.
• Contribute to audits, quality assurance processes, and process enhancement projects aimed at improving efficiency and service quality.
• Participate in continuing clinical and regulatory education initiatives.

Required Qualifications and Experience

• Doctor of Pharmacy (PharmD) or Bachelor of Science in Pharmacy from an accredited institution.
• Possession of an active, unrestricted pharmacist license in good standing; additional state licensures may be necessary depending on business needs.
• Minimum 2 to 5 years of professional pharmacy experience in managed care settings such as health plans, specialty pharmacy, hospitals, ambulatory care, or prior authorization roles.
• Familiarity with pharmacy and medical benefit prior authorization processes is preferred.
• Understanding of utilization management concepts and formulary oversight procedures.

Benefits and Company Offerings

• Diverse health plan coverage options tailored to employee needs.
• Employer-covered premiums for disability and life insurance.
• Generous parental leave policies.
• Starting with 20 days of paid time off plus 10 paid holidays annually.
• Tuition reimbursement programs supporting continuous education.
• 401(k) plan with company contributions.
• Company-paid short- and long-term disability insurance and life insurance coverage.
• Professional growth and development opportunities with ongoing learning initiatives.
• Participation in and support for diversity and inclusion programs.

Additional Information

Imagine360 is committed to equal employment opportunity regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status.

Note for Recruitment Agencies: Applications will only be considered from agencies or partners authorized to work on this role. Unsolicited candidate submissions or direct applications to hiring managers without prior consent will not receive fees.