Clinical Rules & Adjudication Lead; Arabic Speaker – Pharmacist

Position: Clinical Rules & Adjudication Lead (Arabic Speaker – Pharmacist) Location: Town of Poland Job Description This is a remote position. General Overview We are looking for an Arabic-speaking Clinical Rules & Adjudication Lead on behalf of our client. The ideal candidate must have a pharmacy background and will be responsible for managing the full lifecycle of clinical rule development, adjudication accuracy, and system optimization within a PBM environment. The role also serves as a key link between clinical operations, analytics, IT teams, and clients, ensuring data accuracy, evidence-based decisions, and strong clinical outcomes. Additionally, the position requires experience leading and managing teams across multiple locations. Key Responsibilities • Clinical Rules & Adjudication • Lead, optimize, and maintain clinical rules and adjudication logic to ensure safe, appropriate, and cost-effective medication use. • Refine rules based on outcomes, performance insights, and client feedback to improve accuracy and quality. • Manage and mentor a team of pharmacists, including team members located across different regions. • Provide scientific authority, guidance, and support for daily clinical operations. • Client Engagement • Serve as the primary clinical point of contact for clients, explaining rule logic, adjudication outcomes, and system decisions. • Deliver training sessions and presentations in Arabic and English. • Cross-Functional Collaboration • Collaborate with IT, product, and analytics teams to translate clinical requirements into system rules and platform enhancements. • Validate analytics outputs and ensure clinical data accuracy before client delivery. • Data & Performance Monitoring • Use tools such as Excel, Tableau, Power BI to monitor rule performance, identify trends, and support decision-making. • Experience with AI/Python is an added advantage for analytical optimization. • Clinical Excellence & Training • Apply clinical expertise and research background to support evidence-based policies and decisions. • Develop and deliver educational materials to enhance understanding of PBM clinical rule processes. Key Requirements • Must be an Arabic Speaker • Pharmacist qualification (bachelor's in pharmacy or higher) • Experience managing and leading teams across multiple locations • 3–7 years of experience in clinical operations, PBM, adjudication logic, or healthcare analytics • Strong understanding of clinical rules, drug utilization review, or PBM workflows • Strong analytical and problem-solving skills with ability to interpret data • Proficiency in Excel, Tableau, or Power BI (AI/Python is a plus) • Excellent communication skills in Arabic and English • Ability to work closely with cross-functional teams #J-18808-Ljbffr Apply tot his job