The
Clinical Pharmacist is responsible for performing the clinical components of the pharmacy benefit, with a focus on Medicare pharmacy programs, Large Group Medicare operations, formulary administration, regulatory compliance, and clinical review and consultation in support of coverage determinations, appeals, and grievances. This position reviews clinical information, healthcare utilization, and medication history; applies clinical judgment, Medicare Part D regulations, pharmacy policy, and evidence-based criteria to support coverage decisions; and serves as a clinical resource to physicians, prescribers, Medical Directors, interdisciplinary teams, and operational partners. The Clinical Pharmacist also supports member and provider inquiries, improves healthcare outcomes, ensures patient safety, promotes cost-effective medication use, maintains regulatory compliance, and coordinates care efficiently and effectively.
Responsibilities:- Serve as a clinical pharmacy subject matter expert supporting Medicare pharmacy programs, coverage and utilization management processes, formulary administration, and regulatory compliance.
- Review clinical information, utilization, medication history, and documentation; apply regulations, policy, and evidence-based criteria to provide clinically appropriate recommendations.
- Collaborate with prescribers, Medical Directors, interdisciplinary teams, and operational partners to address inquiries and support timely case resolution.
- Identify trends, risks, and process improvements, and communicate recommendations to leadership and key stakeholders.
- Serve as a pharmacy liaison by providing clinical consultation, education, job aids, and training to cross-functional teams.
- Ensure compliance with CMS requirements, internal policies, and applicable quality standards, including support for audits, reporting, and regulatory submissions.
Required Qualifications:- Doctor of Pharmacy (PharmD) or Bachelor of Science in Pharmacy with 5+ years of relevant clinical pharmacy experience.
- Active, unrestricted pharmacist license.
- 5 or more years of relevant clinical pharmacy experience in managed care or a related setting or completion of an accredited AMCP Managed Care Residency.
- Working knowledge of Medicare Part D benefits, formulary administration, compliance, and coverage, appeal, and grievance processes.
- Ability to evaluate clinical information, apply evidence-based criteria and policy, and collaborate with clinical and cross-functional teams to support appropriate treatment, optimize health outcomes, and resolve complex clinical issues.
- Strong analytical, problem-solving, organizational, and communication skills.
- Ability to work independently and within a team setting to achieve goals and meet deadlines.
- Proficiency in Microsoft Word, Excel, and Outlook.
Preferred Qualifications:- Experience supporting Medicare Advantage or Part D coverage reviews, appeals, utilization management, and formulary administration.
- Knowledge of CMS, NCQA, and PQA standards.
- Proficiency in Microsoft Word, Excel, and Outlook.
- Current knowledge and expertise in clinical pharmacology, disease management, and managed care pharmacy.
- Experience with team-based care and interdisciplinary collaboration.
Independence has implemented a "Hybrid" model which consists of Associates working
in the office 3 days a week (Tuesday, Wednesday & Thursday) and remotely 2 days a week (Monday & Friday). This role is designated as a role that fits into the "Hybrid" model. While associates may work remotely on our designated remote days, the
work must be performed in the Tri-State Area of Delaware, New Jersey or PennsylvaniaMust have an Android or iOS device which is compatible with the free Microsoft Authenticator app.
