Clinical Pharmacist – Operations Manager

Job not on LinkedIn

🕒 August 28

🎸 Tennessee – Remote

🎸 Tennessee – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

⚙️ Operations

👻 Ghost score 33%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Career Opportunities International

WebsiteLinkedInAll Job Openings

11 - 50 employees

💼 Consulting

🎯 Recruiter

👥 HR Tech

Consulting • Recruitment • HR Tech

Career Opportunities International is a global executive search firm specializing in sourcing, recruiting, and strategic partnerships. The company focuses on connecting top-tier corporate leaders with leading organizations worldwide. Established in May 1998, C. O. I Executives leverages its dedicated, diverse research team to ensure high-caliber talent meets the right companies. With advanced tools and over 25 years of experience, Career Opportunities International delivers highly qualified candidates efficiently, facilitating sustainable partnerships between stakeholders.

📋 Description

• Lead the day-to-day operations of the Utilization Management Clinical Pharmacist team • Ensure compliant, timely, and evidence-based adjudication of prior authorizations, complex coverage determinations, and appeals • Oversee workload distribution, shift coverage, and capacity planning to meet regulatory and client-specific SLA turn-around times • Coordinate front-line intake/coordination teams with clinical review queues • Serve as the final internal clinical escalation point for complex coverage decisions and high-impact appeal determinations • Own the Utilization Management software engine and oversee system maintenance • Build, test, maintain, and technically configure clinical decision trees and decision-support logic • Translate health plan criteria, medical policies, and clinical guidelines into automated digital workflows • Partner with internal and external teams on platform enhancements, bug resolution, and user acceptance testing • Manage, mentor, and evaluate Clinical Pharmacist Supervisors and the Clinical Pharmacist QA & Training Specialist • Establish benchmarks, conduct performance reviews, track productivity metrics, and implement coaching plans • Foster a collaborative, growth-oriented environment focused on clinical rigor and continuous learning • Oversee recruitment, interviewing, and selection of clinical leadership and staff pharmacists • Direct clinical audit standards, calibration sessions, and quality scorecards • Ensure compliance with state and federal regulations • Analyze operational metrics and generate reporting for senior leadership • Diagnose workflow bottlenecks or clinical quality issues and implement systemic solutions • Perform other duties as required

🎯 Requirements

• Direct experience with custom low-code/no-code rules engine builders, Salesforce Health Cloud, or specialized PBM claim processing architectures • Experience leading remote or hybrid clinical operations teams • Familiarity with comparative effectiveness research, specialty drug pipelines, and advanced medical benefit drug management • Ability to work well with others in a collaborative environment • Ability to get things done with resources you don’t control • Willingness to admit you don’t know and ask for help • Exhibit constant curiosity and a drive to problem solve • Exhibit desire to learn and grow on a continuous basis

🏖️ Benefits

• Fully remote work arrangement • Remote optional in Nashville, TN preferred