[Hiring] Clinical Pharmacist @Gainwell Technologies LLC

Role Description

The Connecticut Clinical Pharmacist will report to the Connecticut Medical Assistance Pharmacy Program’s Manager and will be responsible for participating in all aspects of the Connecticut Medicaid program’s clinical services. This position will involve multiple facets of the pharmacy services including:

• Prior Authorization criteria development
• Coordination of Preferred Drug List (PDL) changes as it relates to the recommendations set forth by the Pharmacy and Therapeutic Committee (P&T)
• Working closely with internal staff in the refinement of the pharmacy management processes and solutions
• Working with the formulary management team on PDL development
• Providing consultation on pharmacy issues to clinical operations representatives
• Facilitating the successful implementation of these programs for customer organizations

The candidate will also provide clinical leadership and indirect oversight to account-based pharmacy prior authorization pharmacists, supporting:

• Consistency in clinical decision-making
• Interpretation of PA criteria
• Escalation management
• Alignment with client expectations

Qualifications

• Minimum of five (5) years of experience in pharmacy benefit management
• Minimum of three (3) years of experience working with a Medicaid PBM account
• Detailed knowledge of Medicaid at the state and federal level
• PharmD required
• Working knowledge of HIPAA regulations and requirements
• Licensed pharmacist required (Connecticut license preferred but not required)
• Managed-Care pharmaceutical service experience plus experience with coaching physicians and prescribers on medication issues, especially on specialty medications
• Ability to communicate succinctly and accurately in both written and verbal English in various group settings from individuals to large groups
• Strong leadership abilities which demonstrate proactive initiative
• Analytical skills which can translate into practical and pragmatic recommendations
• Ability to work independently and in a team environment
• Ability to work effectively and efficiently under stringent timelines
• Excellent organizational, written and oral communication skills
• Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA)
• Proficient PC abilities (basic knowledge in MS Office), work organization, and problem resolution skills
• Proficient on multiple virtual communication platforms (Microsoft Teams, Skype, Zoom, etc.)

Requirements

• Prior Authorization Criteria Development: Evaluate drug and drug class reviews based on sound evidence-based research and processes widely accepted by the medical profession
• Quality Improvement: Contributes to program improvements by using continuous quality improvement processes
• Automated prior authorization: Assist account in developing and maintaining question sets and rules for Intelligent PA
• Medical/Clinical: Upholds clinical integrity of pharmaceutical solutions by staying up to date on medication information
• Engage with the development teams to provide business input and guidance on product enhancements and technical tools
• Participate in corporate pharmacy team meetings

Benefits

• 100% Remote (United States)
• Up to 10% travel may be required
• Pay range: $113,700.00 - $162,400.00 per year
• Generous, flexible vacation policy
• 401(k) employer match
• Comprehensive health benefits
• Educational assistance
• Leadership and technical development academies to help build your skills and capabilities