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
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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 Now
Apply Now