REMOTE Pharmacist-Must Live In New Mexico

Clinical Specialist

The Clinical Specialist manages accessibility, quality, and cost-effectiveness of drug and medical therapy for members and providers. This position focuses on initiating, supporting, and continuing cost-effective, rational drug, and disease therapy, utilizing distinct but inter-related management and cross-departmental functions.

Responsible for providing clinical support services to client plans contracting for clinical services

Support services will include, but not limited to, clinical review, analysis, recommendation, decision and documentation of prior authorization requests, medical exception requests, and appeal requests as required by client contracts and Utilization Management delegation agreements

Review medication request guidelines for clinical appropriateness and operational efficiency

Assist in the revision and creation of new or existing medication request guidelines as indicated

Provide drug information support

Research and provide clinical literature documentation to support prior authorization decisions as indicated

May include preparation of Pharmacy and Therapeutics meeting agenda and associated meeting materials including clinical and financial reviews of individual drugs, drug classes, and current therapy for specific disease states and drug formulary review

Coordinate and assist in the preparation of utilization and compliance reporting for client plans

Ensure timely preparation and review of plan data and client presentations, when required

Coordinate and assist with projects associated with prior authorization program development, implementation and internal and external communications

Provide feedback to Prior Authorization Coordinators regarding the processing of PA cases referred for clinical review

Provide in-service education to Prior Authorization Coordinators regarding topics such as PA guidelines, diagnoses commonly seen as part of the PA review process

For consideration candidates will need a Pharmacy degree (Pharm. D.) or equivalent and an active New Mexico Pharmacist license

Two (2) to five (5) plus years related experience and/or training; or equivalent combination of education and experience

The pay range for this position is $61.75 - $61.75/hr.

Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following:

Medical, dental & vision

Critical Illness, Accident, and Hospital

401(k) Retirement Plan Pre-tax and Roth post-tax contributions available

Life Insurance (Voluntary Life & AD&D for the employee and dependents)

Short and long-term disability

Health Spending Account (HSA)

Transportation benefits

Employee Assistance Program

Time Off/Leave (PTO, Vacation or Sick Leave)

This is a fully remote position.

This position is anticipated to close on Oct 22, 2025.