Job Description
Managed Care Pharmacist
Medical & pharmacy benefit coverage
Team: Clinical Operations
Location: preferred Orlando, FL or Remote (US)
Type: Full-time
The Role
We’re an early-stage healthcare team looking for a
managed care pharmacist with deep knowledge of how specialty medications are covered under medical and pharmacy benefits. You’ll apply your clinical and managed-care expertise to interpret payer coverage and support the team’s work on patient access.
This is a hands-on, individual-contributor role on a small team — a good fit for a pharmacist who likes ownership, variety, and working close to the detail rather than managing others.
What You’ll Do
- Interpret payer coverage. Review medical and pharmacy benefit policies and clinical guidelines to understand coverage requirements for specialty medications.
- Apply clinical judgment. Assess coverage criteria such as diagnosis and indication requirements, step therapy, and prior-authorization requirements.
- Document Product Requirements clearly. Summarize coverage findings in a clear, well-organized, well-sourced manner to create product and technical requirements.
- Stay current. Track changes in payer policies and clinical guidelines and regularly update the requirements.
- Collaborate cross-functionally. Work closely with colleagues across the team, including technical development colleagues.
- Hold a high bar. Bring rigor and attention to detail — cite your sources, double-check your work, and flag anything unclear.
Required Qualifications
The right person is a
pharmacist, genuinely hungry, and hands-on. Early in their career is welcome — as long as they already understand how coverage and utilization management work.
- PharmD, with one or more of the following: a completed managed-care pharmacy residency; experience as a prior-authorization pharmacist; or experience as a pharmacist in a managed-care organization (health plan / PBM).
- Current U.S. Pharmacist License
- Residency or equivalent hands-on experience in coverage / utilization management. You don’t need many years of it, but you do need to genuinely understand this world.
- Demonstrated fluency in medical- and pharmacy-benefit coverage: diagnosis and indication requirements, step therapy, prior authorization, and utilization management.
- A working understanding of the pharmacy vs. medical benefit distinction and why specialty drugs route to one or the other.
- Strong analytical skills and comfort working through dense, unstructured policy material.
- Rigorous and source-driven — you cite, you double-check, you sweat the specifics.
- Self-directed and energized by a small, fast-moving environment. You want to own your work, not oversee others doing it.
- A clear communicator, in writing and in conversation.
Preferred Qualifications
- Broader experience across specialty pharmacy, market access, payer, or PBM settings.
- Comfort working with data and structured information.
- Interest in applying clinical expertise in a technology-oriented environment.
Pay Range
Actual compensation will be determined based on the candidate’s experience, qualifications, and work location. Candidates in different geographic markets may be offered compensation that reflects local market conditions.
Why It’s Worth It
You’ll have real ownership from day one, see your work make a direct difference, and grow with a team at its earliest stage. If you want scope and the chance to shape your role rather than inherit it, this is that opportunity.
