Pharmacist, Clinical Retrospective Case Mgmt - Archimedes

About Us

Archimedes is the industry leader in specialty drug management solutions. Founded with the goal of transforming the PBM industry to provide the necessary ingredients for the sustainability of the prescription drug benefit – alignment, value, and transparency – Archimedes achieves superior results for clients by eliminating tightly held PBM conflicts of interest including drug spread, rebate retention, and pharmacy ownership, and delivering the most rigorous clinical management at the lowest net cost.

Responsibilities

• Review and interpret client data to identify, develop, and manage high-cost clinical interventions and casework.
• Evaluate clinical research and financial data to develop strategic medication management options and coverage recommendations.
• Manage retrospective case requests in compliance with established clinical criteria.
• Assist in the development of clinical policies and pharmacy benefit management programs.
• Contribute to clinical program development for both medical and pharmacy benefits.
• Complete claims editing and audits to ensure accuracy and compliance.
• Develop and deliver clear, data-driven clinical messages to physicians, members, and other clinicians.
• Serve as a peer-to-peer consultant, effectively presenting complex clinical and cost-effectiveness information to various stakeholders.
• Define, document, and present results of clinical interventions and programs to plan sponsors.
• Participate in, adhere to, and support compliance and diversity, equity, and inclusion program objectives.

Qualifications

• Education: Doctor of Pharmacy (PharmD) required.
• Certification/Licenses: Current pharmacist license (RPh) in good standing with a State Board of Pharmacy required. Board of Pharmacy certification preferred for Pharmacotherapy, Ambulatory Care, or Oncology Care.
• Experience: Pharmacy and Medical specialty benefit knowledge and experience required. 3 years clinical or managed care experience or Clinical/Managed Care Pharmacy Residency preferred.
• Skills: Proficient in Microsoft Excel, Power Point, and Word.