[Hiring] Preferred Drug List Pharmacist @Gainwell Technologies LLC

Role Description

As a Preferred Drug List (PDL) Pharmacist supporting the Gainwell Pricing and Contracting team, you will support the clinical, operational, and financial PDL needs of the Delaware Medicaid Fee-for-Service line of business. You will oversee the development, implementation, maintenance, and expansion of a clinically appropriate and fiscally responsible PDL while ensuring adjudication and related communications reflect current program requirements.

• Monitor changes in the drug market.
• Develop prior authorization criteria.
• Support therapeutic class reviews.
• Analyze net cost and utilization trends.
• Collaborate across teams to effectively manage PDL-related information and programs.

Your role in our mission:

• Serve as the primary point of contact and subject matter expert for the State of Delaware on PDL maintenance, development, expansion, and transformation.
• Oversee PDL operations and monitor drug launches, generics, biosimilars, discontinuations, pricing, shortages, patent expirations, Medicaid Drug Rebate Program changes, and other relevant market developments.
• Develop and maintain prior authorization criteria, drug coding and status files, therapeutic class reviews, publications, and Pharmacy & Therapeutics Committee materials and deliverables.
• Analyze clinical evidence, utilization, market share, net cost, and rebate considerations to develop strategic recommendations for drug coverage, therapeutic classes, and utilization management.
• Present clinical and financial recommendations to clients and Pharmacy & Therapeutics Committee stakeholders.
• Drive continuous improvement of PDL operations and financial programs, including value-based and volume-based agreements.

Qualifications

• Active, unrestricted Registered Pharmacist license in any state.
• PharmD or equivalent education and experience, with at least three years of pharmacy benefits management or managed care experience.
• Knowledge of Medicaid at the state and/or federal level, including experience working in Medicaid, healthcare technology, and/or pharmacy analytics.
• Experience supporting Pharmacy & Therapeutics Committee and Drug Utilization Review Board activities.
• Strong analytical, client relationship, communication, and technology skills.

Requirements

• This position is remote.
• Work hours: Eastern Time Zone.
• Supports the Gainwell Pharmacy Center of Excellence (COE).
• Maintain confidentiality and comply with HIPAA and applicable Gainwell policies.
• Maintain regular attendance and effective working relationships with coworkers, clients, members, providers, and customers.

Benefits

• 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.