Clinical Pharmacist
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Job Description
Leveraged Clinical Pharmacist supporting pharmacy benefit management solutions at Gainwell Technologies. Developing clinical prior authorization recommendations, managing preferred drug lists, and ensuring compliance with regulations.
Responsibilities:
- Conduct evidence‑based evaluations of drugs and drug classes using accepted clinical methodologies
- Develop and maintain Gainwell TCRs to support recommendations for Preferred Drug List (PDL) management
- Apply evidence‑based medicine principles to develop clinical PA recommendations and supporting documentation
- Review clinical and pricing data to support the Gainwell clinical PDL team
- Review and monitor prescription claims data and prescribing patterns identified as outliers
- Contribute to the development of Clinical Services publications produced on a weekly, monthly, quarterly, and as‑needed basis
- Support continuous quality improvement by identifying enhancement opportunities
- Provide support to client accounts during implementation, maintenance, and ongoing operations
- Promote collaboration and alignment across the pharmacy business
Requirements:
- 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
Benefits:
- Generous, flexible vacation policy
- 401(k) employer match
- Comprehensive health benefits
- Educational assistance
- Leadership and technical development academies
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