HR Soul is partnering with a growing healthcare organization to identify an experienced Clinical Pharmacist to join its clinical pharmacy team.
This position provides clinical pharmacy expertise across utilization management, prior authorization, medication management, and individualized care planning. The Clinical Pharmacist will evaluate medication requests using evidence-based clinical criteria, identify opportunities to improve medication therapy and outcomes, and collaborate with providers and multidisciplinary teams to promote safe, effective, and cost-conscious medication use.
The ideal candidate combines strong clinical judgment with hands-on experience in prior authorization, utilization management, and patient/member care plan development. Experience within a PBM, managed care organization, health plan, specialty pharmacy, or similar environment will be particularly valuable.
What You’ll Do
Prior Authorization & Utilization Management
Conduct clinical reviews of prior authorization requests using established clinical criteria, evidence-based guidelines, policies, and plan requirements.
Evaluate medication requests based on diagnosis, clinical history, previous therapies, treatment guidelines, and applicable benefits.
Apply utilization management criteria including prior authorization, step therapy, quantity limits, formulary requirements, and specialty pharmacy protocols.
Communicate with prescribers and other healthcare professionals to obtain additional clinical information when necessary.
Document clinical determinations and supporting rationale accurately and within established timelines.
Escalate complex, unusual, or non-routine cases to appropriate clinical leadership.
Medication Management & Care Planning
Develop and maintain individualized medication-related care plans based on clinical history, medication utilization, member needs, and identified gaps in care.
Identify opportunities to improve medication adherence, safety, effectiveness, and overall clinical outcomes.
Recommend clinically appropriate medication interventions and follow-up activities.
Collaborate with healthcare providers and other members of the care team to support implementation of recommended interventions.
Monitor progress and update care plans as clinically appropriate.
Clinical Quality & Process Improvement
Support clinical quality initiatives focused on improving health outcomes and appropriate medication utilization.
Identify opportunities to strengthen prior authorization, utilization management, and clinical pharmacy workflows.
Monitor assigned quality, productivity, and service metrics.
Participate in clinical and operational improvement initiatives.
Contribute clinical expertise to the development and implementation of pharmacy programs and utilization management criteria.
Documentation & Compliance
Maintain accurate, complete, and timely documentation of clinical reviews, determinations, interventions, and care plans.
Ensure work is performed in accordance with applicable federal and state regulations, accreditation standards, organizational policies, and clinical guidelines.
Support internal and external audits when required.
Maintain strict confidentiality and comply with applicable privacy and information-security requirements.
Collaboration
Partner with pharmacists, pharmacy technicians, nurses, providers, operations teams, and other healthcare professionals.
Support the implementation and ongoing improvement of clinical pharmacy programs.
Communicate clinical findings and recommendations clearly and professionally to healthcare providers and internal stakeholders.
Serve as a knowledgeable clinical resource across pharmacy-related initiatives.
Education & Experience
Required
Doctor of Pharmacy (PharmD) degree.
Active, unrestricted pharmacist license in good standing.
Approximately 3–5 years of professional pharmacy experience.
Demonstrated experience developing and managing patient or member care plans.
Preferred
Experience within a PBM, managed care organization, health plan, specialty pharmacy, ambulatory care environment, or similar healthcare setting.
Experience with step therapy, quantity limits, specialty medications, formulary management, and other utilization management strategies.
Experience working with pharmacy claims systems, clinical criteria, electronic medical records, and/or utilization management platforms.
Knowledge, Skills & Abilities
Strong knowledge of medication therapy and evidence-based clinical guidelines.
Ability to independently conduct clinical and prior authorization reviews and reach well-supported clinical determinations.
Strong understanding of medication-related care planning and intervention strategies.
Ability to interpret medical records, medication histories, claims information, and other clinical documentation.
Sound clinical judgment with excellent attention to detail.
Strong written and verbal communication skills.
Ability to communicate effectively with prescribers, healthcare professionals, members of multidisciplinary teams, and internal stakeholders.
Excellent documentation, organization, and time-management skills.
Ability to manage multiple clinical reviews and competing priorities while meeting established deadlines.
Proficiency with pharmacy and clinical technology platforms, electronic records, and standard Microsoft Office applications.
Work Environment
This position offers a hybrid/remote work arrangement, with periodic travel to the Tampa area for meetings, collaboration, training, or other business needs. Travel is expected to be approximately 10% or less.
The position involves extended periods working at a computer and requires the ability to operate standard office, computer, and communications equipment. Some periods of increased workload or time-sensitive clinical activity may require additional flexibility in working hours.
About HR Soul
HR Soul is a people and culture consulting firm helping organizations connect purpose with performance through Talent, Leadership, Strategy, and Culture.
We believe your company has a soul. Our job is to help you find, develop, and empower the people who make it thrive.
Be Human. Be Humble. Be Heroic. Be Hungry.
Confidentiality & Equal Opportunity
HR Soul is conducting this search on behalf of a confidential client. Certain identifying details regarding the organization have intentionally been withheld during the initial recruitment process. Qualified candidates will receive additional information regarding the opportunity as appropriate during the interview process.
HR Soul and its clients are committed to providing equal employment opportunities to qualified individuals without regard to race, color, religion, sex, pregnancy, national origin, age, disability, genetic information, veteran status, or any other status protected by applicable federal, state, or local law.
The information contained in this job description is intended to describe the general nature and level of work performed by individuals assigned to this position. It is not intended to represent an exhaustive list of all duties, responsibilities, qualifications, or working conditions. Responsibilities may be modified based on business and organizational needs.
