Director of Pharmacy Claims & Reimbursement (Remote Eligible)

About the role

Clarest Health is seeking a Director of Pharmacy Claims & Reimbursement to lead a high‑impact team that optimizes pharmacy reimbursement, Medicare Part D services, clinical claims resolution, and patient billing across multiple business lines. This remote‑eligible position reports to the VP of Billing and plays a strategic role in shaping enterprise‑wide pharmacy operations.

Key responsibilities

• Oversee all third‑party claims adjudication and clinical rejection management, including formulary alternatives, prior‑authorization reviews, and complex coverage issue resolution.
• Provide leadership, direction, and workforce planning for Claims Adjudication and Clinical Service Center teams, encompassing pharmacists and pharmacy technicians.
• Ensure consistent performance of the Adjudication team, CSC pharmacists, and technicians in meeting quality, compliance, and reimbursement targets.
• Collaborate with clinical innovation, finance, and operations partners to drive process improvements and cost‑effective solutions.
• Travel up to 20% for on‑site meetings, training, and cross‑functional initiatives at the Clinical Innovation Center in Arizona.

Required profile

• Licensed pharmacist with extensive experience in pharmacy reimbursement, Medicare Part D, and clinical claims management.
• Proven track record of leading multidisciplinary pharmacy teams in a fast‑growing healthcare organization.
• Strong analytical mindset with ability to influence enterprise strategy and drive operational excellence.
• Willingness to work remotely while residing within reasonable proximity to Phoenix, AZ for periodic on‑site attendance.

Required skills

What we offer

• Competitive salary range $185 k–$190 k plus bonus.
• Comprehensive medical, dental, and vision insurance.
• Paid time off, 401(k) with company match, life insurance, and referral bonuses.
• Free virtual care & telemedicine services.
• Wellness support for employees and families.