Clinical Pharmacist Operations Manager

Description

About TruDataRx

TruDataRx, Inc. uses objective clinical data to help clients improve the clinical efficacy and reduce the costs of pharmacy benefits for its members. We are independent from all players in the pharmaceutical manufacturing and distribution industries, enabling us to best serve our clients. We value the following characteristics in our team members:

• Outward Mindset – foundation of our culture, which influences the right behaviors, that leads to results
• Entrepreneurial – the ability to get things done with resources you don’t control
• Humility – deep comfort in knowing when you don’t know and asking questions
• Collaboration – we always give benefit of doubt that each person has something to contribute

Position Summary

The Clinical Pharmacist Operations Manager is responsible for leading the day-to-day clinical operations of the Utilization Management (UM) Pharmacist organization. This role ensures exceptional clinical adjudication accuracy, regulatory compliance, operational efficiency, and strict adherence to turn-around-time (TAT) service level agreements (SLAs) across all prior authorization and appeals workflows. In addition to serving as the operational leader for the UM Pharmacist team, this role acts as the primary business owner for our Utilization Management platform, holding end-to-end responsibility for system maintenance, clinical workflow design, and the technical configuration of clinical decision trees. This position directly manages the Clinical Pharmacist Supervisors and the Clinical Pharmacist QA & Training Specialist, fostering a culture of clinical excellence, data-driven decision-making, and continuous professional development.

Essential Functions

Clinical Operational Leadership

• UM Queue Oversight: Lead the daily operations of the UM Clinical Pharmacist team, ensuring compliant, timely, and evidence-based adjudication of prior authorizations, complex coverage determinations, and appeals.
• Capacity & Service Levels: Oversee clinical workload distribution, shift coverage, and capacity planning to consistently meet or exceed regulatory and client-specific SLA turn-around times.
• Operational Alignment: Partner closely with the PSS Operations Manager to ensure seamless end-to-end coordination between front-line intake/coordination teams and clinical review queues.
• Escalation Management: Serve as the final internal clinical escalation point for complex coverage decisions, high-impact appeal determinations, and peer-to-peer consult strategies.

UM Platform Ownership & Decision Tree Configuration

• Platform Governance: Act as the primary operational and clinical business owner for the Utilization Management software engine.
• Decision Tree Architecture: Oversee the build and directly execute the testing, maintenance, and technical configuration of clinical decision trees and decision-support logic within the UM platform.
• Workflow Optimization: Translate complex health plan criteria, medical policies, and evidence-based clinical guidelines into clear, automated digital workflows that reduce friction and improve pharmacist review efficiency.
• Cross-Functional Tech Liaison: Partner with both internal and external teams to prioritize platform enhancements, troubleshoot system bugs, and oversee user acceptance testing (UAT) for clinical system releases.

Leadership, Coaching & Team Development

• Direct Supervision: Manage, mentor, and evaluate Clinical Pharmacist Supervisors and the Clinical Pharmacist QA & Training Specialist, building strong leadership capabilities across the department.
• Performance Management: Establish clear operational and clinical benchmarks; conduct regular performance reviews, track productivity metrics, and implement targeted coaching plans when variations occur.
• Culture & Engagement: Foster a collaborative, growth-oriented environment focused on clinical rigor, quality patient care, and continuous learning.
• Talent Acquisition: Oversee recruitment, interviewing, and selection of incoming clinical leadership and staff pharmacists.

Quality Assurance, Compliance & Performance Reporting

• Clinical Quality Framework: Direct the Clinical QA & Training Specialist in establishing audit standards, calibration sessions, and quality scorecards across the pharmacist team.
• Regulatory Compliance: Ensure all clinical adjudication processes comply strictly with state/federal regulations and align with best practices across the industry.
• Analytics & Dashboards: Analyze operational metrics (case accuracy, overturn rates, average review times, decision tree pass-through rates) to generate actionable reporting for senior leadership.
• Root Cause Analysis: Diagnose underlying drivers of workflow bottlenecks or clinical quality drops and implement sustainable, systemic solutions.
• Other duties as required.*

*This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee. Duties, responsibilities and activities may change or new ones may be assigned at any time with or without notice.

Requirements

Preferred Qualifications

• 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.

Company Standard Requirements:

• 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