Utilization Management Clinical Pharmacist

About Tru Data Rx

Tru Data Rx , Inc. uses objective clinical data to help clients improve the clinical efficacy and reduce the costs of pharmacy benefits for its members. We are independent from all players in the pharmaceutical manufacturing and distribution industries, enabling us to best serve our clients. We value the following characteristics in our team members:

• Outward Mindset - foundation of our culture, which influences the right behaviors, that leads to results
• Entrepreneurial - the ability to get things done with resources you don't control
• Humility - deep comfort in knowing when you don't know and asking questions
• Collaboration - we always give benefit of doubt that each person has something to contribute

The Clinical Pharmacist I is a volume-driven, production-focused role centered entirely on the clinical adjudication of initial prior authorization (PA) requests. Operating in a fast-paced, virtual environment, this individual will critically evaluate medical necessity and accurately apply plan criteria, regulatory guidelines, and evidence-based comparative effectiveness data. The Clinical Pharmacist I ensures timely, accurate determinations while providing essential foundational support to the Pharmacy Support Specialist (PSS) team.

• High-Volume Case Review:
  Evaluate and adjudicate initial prior authorization (PA) requests efficiently, ensuring strict accuracy against established clinical criteria and protocols.
• Criteria Application:
  Precisely apply plan-specific criteria, evidence-based clinical guidelines, comparative effectiveness research data, and strict regulatory standards to deliver timely determinations.
• Database Navigation:
  Leverage specialized clinical drug databases to analyze drug indications, dosage limits, and distinct clinical parameters during the review process.

• Empathetic Communication:
  Articulate approval and denial decisions clearly, professionally, and empathetically through structured documentation and direct communication with members and healthcare providers.
• PSS Coordination:
  Serve as a reliable clinical resource for the Pharmacy Support Specialist (PSS) team, providing clear guidance and clinical interpretations for complex inquiries from prescribers, pharmacies, and members.
• Knowledge Maintenance:
  Maintain up-to-date, comprehensive knowledge of modern managed care trends, evolving comparative effectiveness data, clinical guidelines, and utilization management workflows.

• Workflow Optimization:
  Actively support and contribute to continuous process improvement initiatives to streamline internal operational workflows, boost team efficiency, and optimize turnaround times (TAT).
• Team Alignment:
  Perform additional operational duties and tasks as required to support broader clinical team production goals.

Other duties as required.*

* This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee. Duties, responsibilities and activities may change or new ones may be assigned at any time with or without notice.

• Doctor of Pharmacy (PharmD) degree from an accredited institution.
• Active, unrestricted pharmacist license in your state of residence.

• Clinical Acumen:
  Strong foundational clinical skills with a demonstrated ability to critically evaluate and apply complex clinical data to individual case reviews.
• Remote Productivity:
  Self-motivated, highly organized, and capable of maintaining high-volume production metrics while working effectively in a virtual/remote team environment.
• Proc…