Clinical Policy Operations Professional 2

**Become a part of our caring community** ========================================= The Clinical Policy Operations Professional 2 provides operational support to clinical pharmacists for the implementation, maintenance, submission, and ongoing management of clinical policies, drug lists, and benefit requirements. This role focuses on accurately translating approved clinical strategies into operational systems and tools, requiring strong attention to detail, independent problem solving, and consistent execution within established processes. The Clinical Policy Operations Professional 2 ensures accuracy and compliance for utilization management (UM) criteria within the Clinical Policy System, operational guidance documentation, and the submission and maintenance of policies provided to external accreditation and review bodies. They collaborate with healthcare professionals, pharmacists, and business stakeholders to operationalize clinical policy strategies and perform quality analysis and reporting to ensure effective operational execution. This role creates process and training documentation as appropriate. They understand department, and organizational strategy and operating objectives, including their linkages to related areas. They make decisions regarding their own work methods, occasionally in ambiguous situations, and require minimal direction while seeking guidance when needed. They follow established guidelines and procedures. Success in this role requires strong attention to detail, comfort working within established processes, sound judgement, and the ability to manage recurring operational responsibilities with a high degree of accuracy. * Collaborates with Clinical Subject Matter Experts to translate complex clinical recommendations into standardized policy criteria and operational requirements within formulary and clinical policy systems. * Interprets Medicare and state\-specific Medicaid regulations, benefit requirements, and operational guidance to support the accurate implementation and maintenance of state\-specific clinical policies and utilization management strategies * Partners with clinical, operational, and business stakeholders to ensure clinical policy intent is accurately reflected in formulary structures, utilization management criteria, and system configuration. Performs detailed reviews to ensure policy configurations and operational guidance align with approved clinical and business requirements * Supports cross\-functional efforts related to policy implementation, operational processes, and workflow management across clinical and business teams * Participates in cross\-functional initiatives to streamline policy implementation, workflow management, and operational review processes across clinical and operational teams. **Use your skills to make an impact** ===================================== **Required Qualifications** * Bachelor's degree * Less than 5 years of technical experience * Strong collaboration an