Principal Healthcare Evaluator

Title / Position: Principal Healthcare Clinical Evaluator / Pharmacist Pay Rate: $45-50/hr Location: Raleigh, NC On-site 3 days per week Remote/Hybrid allowance: 2 days remote Degree: Doctor of Pharmacy, Doctor of Medicine or Doctor of Dental Surgery Certifications: must be a registered Pharmacist Position Overview The Healthcare Clinical Evaluator Principal plays a critical role in supporting high quality, patient centered pharmacy services across North Carolina Medicaid. This position provides advanced clinical expertise in the review and adjudication of prior authorization requests, ensuring alignment with state approved criteria and contributing to the broader mission of improving public health outcomes. This is a hybrid position requiring a balance of independent analytical work, multidisciplinary collaboration, and onsite engagement with the clinical evaluation team. RequirementsExperience 8+ years of related experience in clinical pharmacy, prior authorization review, managed care, or equivalent advanced pharmacy practice setting. Technical Skills Demonstrated ability to: Work effectively across multiple computer systems and multi screen environments. Perform detailed clinical analysis with precision and independent judgment. Maintain sustained concentration for long review periods. Adapt to a flexible schedule in response to workflow demands. ResponsibilitiesClinical Leadership & Prior Authorization Review Serve as a subject matter expert in prior approval pharmacy services, applying deep clinical knowledge to evaluate requests in accordance with North Carolina's approved criteria, policies, and guidelines. Lead, manage, and support high complexity case reviews, ensuring consistency, accuracy, and adherence to established clinical standards. Interdisciplinary Collaboration Work closely with clinical and medical staff, including pharmacists, pharmacy technicians, and other healthcare professionals, to ensure accurate and efficient adjudication of prior approval requests. Collaborate with team members to resolve complex clinical cases, share insights, and contribute to continuous process improvement. Operational & Analytical Expertise Leverage a strong working knowledge of clinical pharmacy operations, including formulary management, medication therapy management, and therapeutic alternatives. Apply advanced analytical skills to assess clinical documentation, evaluate appropriateness of therapy, and support decision making. Utilize critical thinking and problem solving skills to facilitate consensus among stakeholders, address escalated inquiries, and ensure alignment with NC DHB Outpatient Pharmacy criteria. Technology & Workflow Management Navigate multiple computer systems simultaneously and manage workflows using multi screen setups. Maintain high levels of focus and accuracy over extended periods when reviewing clinical documentation and system data. Support operational efficiency by adapting to evolving tools, platforms, and digital processes. EEO Employer Apex Systems is an equal opportunity employer. We do not discriminate or allow discrimination on the basis of race, color, religion, creed, sex (including pregnancy, childbirth, breastfeeding, or related medical conditions), age, sexual orientation, gender identity, national origin, ancestry, citizenship, genetic information, registered domestic partner status, marital status, disability, status as a crime victim, protected veteran status, political affiliation, union membership, or any other characteristic protected by law. Apex will consider qualified applicants with criminal histories in a manner consistent with the requirements of applicable law. If you have visited our website in search of information on employment opportunities or to apply for a position, and you require an accommodation in using our website for a search or application, please contact our Employee Services Department at [email protected] or 844-463-6178. Apex Systems is a world-class IT services company that serves thousands of clients across the globe. When you join Apex, you become part of a team that values innovation, collaboration, and continuous learning. We offer quality career resources, training, certifications, development opportunities, and a comprehensive benefits package. Our commitment to excellence is reflected in many awards, including ClearlyRated's Best of Staffing® in Talent Satisfaction in the United States and Great Place to Work® in the United Kingdom and Mexico. Apex uses a virtual recruiter as part of the application process. Click here for more details. Apex Benefits Overview: Apex offers a range of supplemental benefits, including medical, dental, vision, life, disability, and other insurance plans that offer an optional layer of financial protection. We offer an ESPP (employee stock purchase program) and a 401K program which allows you to contribute typically within 30 days of starting, with a company match after 12 months of tenure. Apex also offers a HSA (Health Savings Account on the HDHP plan), a SupportLinc Employee Assistance Program (EAP) with up to 8 free counseling sessions, a corporate discount savings program and other discounts. In terms of professional development, Apex hosts an on-demand training program, provides access to certification prep and a library of technical and leadership courses/books/seminars once you have 6+ months of tenure, and certification discounts and other perks to associations that include CompTIA and IIBA. Apex has a dedicated customer service team for our Consultants that can address questions around benefits and other resources, as well as a certified Career Coach. You can access a full list of our benefits, programs, support teams and resources within our 'Welcome Packet' as well, which an Apex team member can provide.

Created: 2026-03-06