| Department: Clinical Services |
Job Status: Full Time |
| FLSA Status: Exempt |
Reports To: CEO |
| Grade/Level: |
Amount of Travel Required: 5%-15% |
| Work Schedule: |
Positions Supervised: n/a |
| Generally 8:00 a.m. to 5:00 p.m., Monday - Friday. However, the position may require some work outside of traditional office hours. |
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POSITION SUMMARY
The Clinical Pharmacist acts as an outward facing, dedicated clinical resource for assigned accounts, and typically has direct client contact. Builds relationships with clients and serves as their primary point of contact for clinical program support. The Clinical Pharmacist will coordinate with other Clinical Pharmacists, Program Managers, Account Executives, and Account Managers to enhance and support their understanding of related Pharmacy Benefit Management (PBM) programs. Additionally, the Clinical Pharmacist will develop and maintain appropriate clinical, evidence-based documentation that supports programs. The primary functions involve ensuring that Heritage Health Solutions is able to provide clinically sound programs in the most cost-effective manner and utilize technology to implement our client's programs. The Clinical Pharmacist is responsible for providing information as it relates to Heritage's clinical goals and is a primary resource regarding all clinical pharmacy questions.
ESSENTIAL FUNCTIONS
Reasonable Accommodations Statement
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable Accommodations may be made to enable qualified individuals with disabilities to perform the essential functions.
Essential Functions Statement(s)
- Provides guidance for clinical oversight of the pharmacy programs.
- Responsible for oversight of clinical decision-making aspects of Heritage pharmacy programs.
- Formulary and Prior Authorization Management
- Data analytics
- Has periodic consultation with practitioners in the pharmacy programs
- Provide input to teaming partners and clients, as needed, regarding clinical content of new programs and for maintenance of existing programs.
- Participate in RFP process as clinical SME
- Responsible for working on cross functional teams working on new program/service development.
- Facilitation of communication and education to clients, and internal staff regarding clinical daily issues and objectives.
- Provide support to operational departments on the implementation of various programs and daily functioning in support of client programs.
- Assists Customer Care, Account Management, and other internal customers in responding to and resolving pharmacy-related inquiries from clients, pharmacies, providers, or members.
- Maintain open lines of communication with other functional/areas departments.
- Participate in multi-departmental meetings and committees to accomplish projects.
- Responsible for creating and maintaining clinical department policy and procedures
- Participate in implementation of new client pharmacy programs as needed. Implementation included the discussion of existing clinical guidelines, individualization of clinical guidelines, processes and procedures to client specifics, and review of denial management processes.
- Provide input to documentation of client specific processes including communication procedures, plan demographics, criteria selection, denial management procedures, and reporting requirements.
- Manage the clinical relationship with clients.
- Attends client meetings, including quarterly business reviews, and presents relevant clinical information including cost trends and formulary opportunities.
- Establish and maintain client relationships at appropriate levels, including medical and pharmacy directors, benefit managers, contract officers, and consultants.
- Lead/facilitate a multi-disciplinary team to discuss the ongoing needs of the clients.
- Recognize a diversity of problem-solving skills and how they can lead to better solutions.
- Maintain a commitment to Heritage's goals that encourage equity and diversity.
- Responsible for staying current with clinical literature and guidelines.
- Create and manage clinical department budget.
- Other job-related duties as assigned.
POSITION QUALIFICATIONS
Competency Statement(s)
- Accuracy - Ability to perform work accurately and thoroughly.
- Active Listening - Ability to actively attend to, convey, and understand the comments and questions of others.
- Adaptability - Ability to adapt to change in the workplace.
- Business Acumen - Ability to grasp and understand business concepts and issues.
- Analytical Skills - Ability to use thinking and reasoning to solve a problem.
- Coaching and Development - Ability to provide guidance and feedback to help others strengthen specific knowledge/skill areas.
- Communication, Oral - Ability to communicate effectively with others using the spoken word.
- Communication, Written - Ability to communicate in writing clearly and concisely.
- Customer Oriented - Ability to take care of the customers' needs while following company procedures.
- Strategic Planning - Ability to develop a vision for the future and create a culture in which the long-range goals can be achieved.
- Decision Making - Ability to make critical decisions while following company procedures.
- Relationship Building - Ability to effectively build relationships with customers and co-workers.
- Project Management - Ability to organize and direct a project to completion.
- Problem Solving - Ability to find a solution for or to deal proactively with work-related problems.
- Detail Oriented - Ability to pay attention to the minute details of a project or task.
- Presentation Skills - Ability to effectively present information publicly.
- Management Skills - Ability to organize and direct oneself and effectively supervise others.
- Diversity Oriented - Ability to work effectively with people regardless of their age, gender, race, ethnicity, religion, or job type.
- Judgment - The ability to formulate a sound decision using the available information.
- Deductive Reasoning - Ability to apply principles of logical or scientific thinking to a wide range of intellectual and practical problems.
Leadership Competencies - These are the skills needed to drive the organization onto the cutting edge of new technologies. Leadership Competencies form the basic structure that separates leaders from bosses.
- Leadership Abilities - Displays attributes that make people glad to follow. Provides a feeling of trust. Rallies the troops and builds morale when the going gets tough.
- Visioning Process - Applies effort to increase productivity in areas needing the most improvement. Creates and sets goals (visions). Senses the environment by using personal sway to influence subordinates and peers. Gain commitment by influencing team to set objectives and commit to a process. Reinforces change by embracing it, preventing relapse into prior state.
- Create and Lead Teams - Develops high-performance teams by establishing a spirit of cooperation and unity for achieving goals. Quickly takes teams out of the storming and norming phases and into the performing phase.
- Assess Situations Quickly and Accurately - Takes charge when the situation demands it. Makes the right things happen on time.
- Foster Conflict Resolutions (Win-Win) - Effectively handles disagreements and conflicts. Settles disputes by focusing on solving the problems, without offending egos. Provides support and expertise to other leaders with respect to managing people. Evaluates the feasibility of alternative dispute resolution mechanisms.
- Project Management - Tracks critical steps in projects to ensure they are completed on time. Identifies and reacts to the outside forces that might influence or alter the organization's goals. Establishes a course-of-action to accomplish a specific goal. Identifies, evaluates and implements measurement systems for current and future projects.
- Implement Employee Involvement Strategies - Develops ownership by including employees in the planning and decision-making process. Enables employee success, while maintaining the well-being of the organization. Develops processes to engage employees in achieving the objectives of the organization. Gives employees the authority to get things accomplished in the most efficient and timely manner.
- Coach and Train Peers and Subordinates - Recognizes that learning happens at every opportunity and treats mistakes as learning events. Develop future leaders by being involved in the company mentoring program. Provides performance feedback, coaching and career development to teams and individuals to maximize their probability of success. Ensure performance feedback is an integral part of the day-to-day activities.
SKILLS & ABILITIES
Education: Required minimum: Bachelor's degree in pharmacy. Pharm D preferred. Required - must be a licensed pharmacist in the state of Texas.
Experience: Minimum of 2 years pharmacy practice experience required.
Computer Skills
Microsoft Office (Word, PowerPoint, Excel, Outlook); SharePoint; Medispan
Certificates & Licenses
Current unrestricted Texas State Pharmacy License required.
Valid State Issued Driver's License
Other Requirements
Exceptional clinical skills and the ability to apply sound clinical judgment to a variety of situations. Ability to reason and translate clinical information into a manner appropriate for clinical systems and clinical/non-clinical audiences. Emphasis on problem-solving skills, including identifying and accepting a challenging situation and creating and implementing a solution. Requires superior attention to details in order to assure projects are clinically, editorially, and systems accurate and can be operationalized. Must be able to effectively interact with peers and other employees to positively impact joint activities and projects. Must demonstrate a sense of urgency to take care of clients to ensure complete satisfaction and compliance. Energetic, forward-thinking, creative, strategic thinker.
Preferred experience
Post graduate experience in Pharmacy Services, knowledge of the PBM industry,
IV Certification, Specialty Pharmacy, formulary management, pharmacy claims, PA Criteria and Value Based Strategy, Policies and Procedures development,
pharmaceutical industry acumen, managed care principles, knowledge of Medicare and Medicaid programs, supervisory experience.
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Heritage Health Solutions, Inc.
$110,000 to $140,000 DOE - Pay is dependent on experience and qualifications. Benefits package: Employer heavily subsidized Medical, Dental, Vision. Employer paid life insurance, AD&D, STD, LTD. Voluntary life insurance available as well as other suppleme
Sep 16, 2025