Clinical Policy Operations Professional 2

About the role

The Clinical Policy Operations Professional 2 provides operational support to clinical pharmacists for the implementation, maintenance, submission, and ongoing management of clinical policies, drug lists, and benefit requirements. This role focuses on accurately translating approved clinical strategies into operational systems and tools, requiring strong attention to detail, independent problem solving, and consistent execution within established processes.

Responsibilities

• Accurately translates approved clinical strategies into operational systems and tools
• Ensures accuracy and compliance for utilization management (UM) criteria within the Clinical Policy System, operational guidance documentation, and the submission and maintenance of policies provided to external accreditation and review bodies
• Collaborates with healthcare professionals, pharmacists, and business stakeholders to operationalize clinical policy strategies
• Performs quality analysis and reporting to ensure effective operational execution
• Creates process and training documentation as appropriate
• Understands department, and organizational strategy and operating objectives, including their linkages to related areas

Requirements

• Bachelor's degree
• Less than 5 years of technical experience
• Strong collaboration and relationship-building skills
• Excellent written and verbal communication skills
• Excellent planning and organizational skills
• Demonstrated ability to manage complex operational processes requiring a high degree of accuracy, attention to detail, and independent problem solving
• Working knowledge of all Microsoft Office applications, including Word, Excel and Outlook
• Ability to work on multiple, competing projects
• Ability to successfully handle change in a fast-paced environment
• Passionate about contributing to an organization focused on continuously improving consumer experiences
• Proven ability to collaborate across departments and lines of business to support alignment and operational execution

Qualifications

• Experience with data analysis, reporting, and process measurement tools (e.g., Excel, Access, Power BI)
• Previous experience in pharmacy benefits management or healthcare operations
• Experience supporting Medicare and/or managed Medicaid programs
• Experience working in cross-functional operational, policy, or implementation environments

Skills

Strong attention to detail, comfort working within established processes, sound judgement, and the ability to manage recurring operational responsibilities with a high degree of accuracy.

Benefits

Not specified

Pay

$65,000 - $88,600 per year

Schedule

Not specified