Agadia Systems Inc

Role Description 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. Qualifications - PharmD, with one or more of the following: - a completed managed-care pharmacy residency; - experience as a prior-authorization pharmacist; - 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. - 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. Benefits - 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.