Job Details: Tittle: Clinical Pharmacist – Prior Authorization & Denials Location : 100% Remote Duration: 06 Months Contract (possible extension or conversion) Schedule Notes: Monday - Friday 9am - 6pm EST Training Schedule will be the same 100% Remote Position Summary: The Lead Analyst is responsible for translating state Medicaid Preferred Drug List (PDL) requirements into accurate, compliant, and operationally executable formulary implementations. This role requires strong analytical skills, formulary and pharmacy benefit knowledge, requirements management expertise, and the ability to coordinate cross-functional implementation efforts across Operations, Configuration, Testing, and Clinical teams. This is a non-pharmacist role. Pharmacists retain responsibility for clinical interpretation, clinical decision-making, and approval of ambiguous or high-risk clinical requirements. Key Responsibilities: The successful candidate must demonstrate the ability to: Analyze and interpret complex formulary, pharmacy benefit, and regulatory requirements and translate them into clear operational specifications. Review and compare large formularies, drug files, and implementation documents to identify additions, removals, utilization management changes, and operational impacts. Manage multiple concurrent implementations while maintaining accuracy, compliance, and adherence to client and regulatory deadlines. Develop comprehensive implementation documentation that clearly defines formulary status, prior authorization requirements, quantity limits, step therapy rules, effective dates, and other coverage restrictions. Partner effectively with pharmacists, configuration teams, testing teams, and operational stakeholders to ensure successful implementation of approved requirements. Define expected business outcomes and validate implementation results through detailed review of testing and post-implementation documentation. Investigate and resolve implementation issues by determining whether root causes are related to requirements, configuration, data, testing, or clinical interpretation. Maintain complete, audit-ready documentation, approvals, version control, and implementation evidence. Identify process improvement opportunities and contribute to operational efficiency, quality, and scalability initiatives. Schedule Expectations State Medicaid PDL implementation work is driven by regulatory and client deadlines. Candidates must demonstrate flexibility to support planned weekend, holiday, and after-hours coverage as part of a team rotation to ensure timely, compliant delivery of services. Skills: Required Qualifications: 2+ years of experience in pharmacy benefit management (PBM), health plan pharmacy operations, formulary operations, benefit configuration, pharmacy claims, prior authorization, or related healthcare operations. Demonstrated experience translating business, formulary, or regulatory requirements into operational processes or system configurations. Working knowledge of: Medicaid and/or commercial pharmacy benefits Formulary management concepts National Drug Codes (NDCs) Prior authorization programs Step therapy programs Quantity limit management Pharmacy claims adjudication concepts Strong analytical and critical-thinking skills with the ability to evaluate large data sets and identify exceptions, discrepancies, and operational impacts. Advanced proficiency in Microsoft Excel, including data reconciliation, comparisons, lookups, filtering, and analysis. Strong documentation, organizational, and project coordination skills. Ability to communicate effectively with technical, operational, and clinical stakeholders. Ability to work independently and exercise sound judgment when identifying risks, gaps, or issues requiring escalation. Demonstrated ability to manage competing priorities in a deadline-driven environment. Preferred Qualifications: State Medicaid PDL implementation experience. PBM formulary management experience. Experience supporting formulary maintenance, benefit configuration, or pharmacy claims platforms. Experience with drug database vendors such as Medi-Span or First Databank. Experience with SQL, data analysis, automation tools, or reporting platforms. Pharmacy Technician certification. Experience supporting audits, regulatory implementations, or client submission processes. Experience leading implementation efforts or serving as a primary point of coordination across multiple stakeholder groups. 3 Non-Negotiable Skills: Strong excel experience (vlookup & formulas) Attention to detail Problem solving/ critical thinking