[Hiring] PBM Leveraged Clinical Pharmacist @Gainwell Technologies LLC

Role Description

The Leveraged Clinical Pharmacist reports to the PBM Director of Clinical Services and is responsible for supporting key functions across Gainwell Technologies Pharmacy Benefit Management (PBM), including business development, implementation, clinical services, and leveraged operations. This position contributes to the development, execution, and ongoing support of pharmacy programs through:

• Prior authorization (PA) criteria development
• Coordination of Pharmacy and Therapeutics (P&T) Committee and DUR Board activities
• Collaboration on Preferred Drug List (PDL) strategy
• Enhancement of pharmacy management solutions
• Consultation on pharmacy-related matters that support customer implementation and ongoing operations

Primary Responsibilities include:

• Therapeutic Class Review (TCR) Development: Conduct evidence-based evaluations of drugs and drug classes using accepted clinical methodologies. Develop and maintain Gainwell TCRs to support recommendations for PDL management and clinical PA criteria.
• Prior Authorization and Clinical Program Development: Apply evidence-based medicine principles to develop clinical PA recommendations and supporting documentation for presentation to the P&T Committee and/or DUR Board. Contribute to the development and maintenance of question sets and rules configured within the PA Engine and electronic prior authorization (ePA) system.
• Preferred Drug List (PDL) Support: Review clinical and pricing data to support the Gainwell clinical PDL team in preparation for state P&T Committee and DUR Board meetings.
• Retrospective DUR Initiatives: Review and monitor prescription claims data and prescribing patterns identified as outliers through internal and external analyses to develop relevant retrospective DUR initiatives.
• Clinical Services Publications: Contribute to the development of Clinical Services publications produced on a weekly, monthly, quarterly, and as-needed basis.
• Program Improvement and Clinical Support: Support continuous quality improvement by identifying enhancement opportunities, developing solutions to improve operational efficiency, maintaining the clinical integrity of pharmaceutical solutions, and contributing to pharmacy best practices across the organization.
• Client, Product, and Business Support: Provide support to client accounts during implementation, maintenance, and ongoing operations. Serve as a subject matter expert for pharmacy product development, sales pursuits, request for proposal (RFP) responses, and due-diligence initiatives, and partner with development teams to provide business guidance on product enhancements and technical tools.
• Cross-Functional Collaboration: Promote collaboration and alignment across the pharmacy business in support of Gainwell accounts.

Qualifications

• Doctor of Pharmacy (PharmD) degree required.
• Active Pharmacist license is required.
• Minimum of 5 years of experience in pharmacy benefit management.
• Minimum of 3 years of experience supporting a Medicaid PBM account.
• Demonstrated knowledge of Medicaid requirements at the state and federal levels.
• Working knowledge of HIPAA regulations and related compliance requirements.
• Proficient in PowerPoint and comfortable delivering presentations both within the organization and to external audiences.

Requirements

• Strong written and verbal communication skills, including the ability to communicate clearly and accurately in individual and group settings.
• Demonstrated leadership capability and a proactive, solution-oriented approach.
• Strong analytical skills and the ability to translate findings into practical recommendations.
• Ability to work independently and collaboratively in a team environment.
• Ability to manage competing priorities and perform effectively within tight timelines.
• Ability to maintain confidentiality and comply with HIPAA requirements.
• Proficiency in Microsoft Office, virtual communication platforms, and general organizational and problem-solving skills.

Benefits

• Generous, flexible vacation policy
• 401(k) employer match
• Comprehensive health benefits
• Educational assistance
• Leadership and technical development academies to help build skills and capabilities